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International Orthopaedics

, Volume 43, Issue 6, pp 1365–1370 | Cite as

Does the body mass index influence the long-term survival of unicompartmental knee prostheses? A retrospective multi-centre study

  • Saverio AffatatoEmail author
  • Dalila Caputo
  • Barbara Bordini
Original Paper
  • 152 Downloads

Abstract

Purpose

The effect of being obese on the long-term survival of total joint arthroplasty is persistently discussed. Considering only studies with large cohort of patients and meta-analysis, a high body mass index has been correlated with a higher incidence of complication but not univocally with a lower survival rate. In this study, we analyzed, retrospectively, the data of patients that received unicompartmental knee prostheses in order to examine if obesity has an effect on clinical outcomes.

Methods

A retrospective multi-centre study was carried out on 4964 unicompartmental knee replacements between July 2000 and December 2016, the patients involved were 3976, with 988 bilateral cases. The patients were categorized into three groups: non-obese with a body mass index (BMI) < 30 kg/m2, obese with BMI ranged between 30 and 39 kg/m2, and morbidly obese (BMI ≥ 40 kg/m2). The outcome was measured using the Cox proportional hazards model with end point UKA revision for any reasons. Results were stratified for sex, age, weight, and bi-laterality.

Results

The morbidly obese group was significantly younger and required a significantly longer operating time. No statistical significant differences were observed considering the BMI groups in terms of type of insert, type of tibial component, prosthetic condyle, and prosthesis fixation (p > 0.05; chi-square test).

Conclusions

Obese and morbidly obese patients have as much to gain from total knee replacement as non-obese patients.

Keywords

UKA Outcomes Body mass index Body weight Obesity Morbidly obese Normal 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The protocol was not submitted for ethical approval due to its retrospective and analytical nature.

References

  1. 1.
    Affatato S (2014) Surgical techniques in total knee arthroplasty (TKA) and alternative proceduresGoogle Scholar
  2. 2.
    Affatato S, Spinelli M, Zavalloni M, et al (2008) Unicompartmental knee prostheses: in vitro wear assessment of the menisci tibial insert after two different fixation methods. Phys Med Biol 53.  https://doi.org/10.1088/0031-9155/53/19/006
  3. 3.
    Tian S, Liu J, Yuan W, et al (2017) Minimally invasive unicompartmental knee replacement: midterm clinical outcome. PLoS One 1–9Google Scholar
  4. 4.
    Wang C, Guo Y, Shi J, Chen W (2017) A numerical investigation into the effects of overweight and obesity on total knee arthroplasty. J Healthc Eng 2017:1–8Google Scholar
  5. 5.
    Roach BL, Matheny JB, Spinelli M et al (2012) Bi-unicondylar knee replacement laxity with changes to simulated soft tissue constraints. Proc Inst Mech Eng H J Eng Med 227:27–36.  https://doi.org/10.1177/0954411912459420 CrossRefGoogle Scholar
  6. 6.
    Woo YL, Qiang Y, Chen J et al (2017) Orthopaedic Surgery does obesity influence early outcome of fixed-bearing unicompartmental knee arthroplasty? J Orthop Surg 25:1–5.  https://doi.org/10.1177/2309499016684297 CrossRefGoogle Scholar
  7. 7.
    Unknown (2000) Obesity : preventing and managing the global epidemic Report of aGoogle Scholar
  8. 8.
    Battaglia S, Taddei P, Castiello E, et al (2014) Combined effect of the body mass index and implant size on the wear of retrieved total knee prostheses. J Mech Behav Biomed Mater 38.  https://doi.org/10.1016/j.jmbbm.2014.06.012
  9. 9.
    Andrew JG, Palan J, Kurup HV et al (2008) Obesity in total hip replacement. J Bone Joint Surg (Br) 90:424–429CrossRefGoogle Scholar
  10. 10.
    Swinburn B, Dietz W, Kleinert S (2015) A Lancet Commission on obesity. Lancet 386:1716–1717.  https://doi.org/10.1016/S0140-6736(15)00722-9 CrossRefGoogle Scholar
  11. 11.
    Bookman JS, Schwarzkopf R, Deshmukh AJ (2018) Obesity the modifiable risk factor in total joint arthroplasty arthroplasty total hip arthroplasty total knee arthroplasty obesity risk factors. Orthop Clin N Am iN press.  https://doi.org/10.1016/j.ocl.2018.02.002
  12. 12.
    Losina E, Walensky RP, Reichmann WM et al (2011) Impact of obesity and knee osteoarthritis on morbidity and mortality in older Americans. Ann Intern Med 154:217–226.  https://doi.org/10.1059/0003-4819-154-4-201102150-00001.Impact CrossRefGoogle Scholar
  13. 13.
    Eknoyan G (2008) Historical note -Adolphe Quetelet ( 1796 – 1874 )— the average man and indices of obesity. Nephrol Dial Transpl 23:47–51.  https://doi.org/10.1093/ndt/gfm517 CrossRefGoogle Scholar
  14. 14.
    Wikipedia (2018) Body mass index. In: 2018. https://en.wikipedia.org/wiki/Body_mass_index. Accessed 2 May 2018
  15. 15.
    Blackburn H, Jr DJ (2014) Commentary : origins and evolution of body mass index (BMI): continuing saga. Int J Epidemiol 43:665–669.  https://doi.org/10.1093/ije/dyu061 CrossRefGoogle Scholar
  16. 16.
    Keys A, Fidanza F, Karvonen MJ et al (2014) Indices of relative weight and obesity. Int J Epidemiol 43:655–665.  https://doi.org/10.1093/ije/dyu058 CrossRefGoogle Scholar
  17. 17.
    Avenell A, Broom J, Brown TJ et al (2004) Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Heal Technol Assess 8:iii–iv, 1-182Google Scholar
  18. 18.
    Reyes C, Leyland KM, Peat G, Arden NK (2016) Europe PMC Funders Group Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: a population-based cohort study. Arthritis Rheumatol 68:1869–1875 . doi:  https://doi.org/10.1002/art.39707.Association
  19. 19.
    Chaganti RK, Lane NE (2011) Risk factors for incident osteoarthritis of the hip and knee. Curr Rev Musculoskelet Med 4:99–104.  https://doi.org/10.1007/s12178-011-9088-5 CrossRefGoogle Scholar
  20. 20.
    Leung Y, Jr JCA, Noviani M et al (2015) Association between body mass index and risk of total knee replacement, the Singapore Chinese Health Study. Osteoarthr Cartil 23:41–47.  https://doi.org/10.1016/j.joca.2014.10.011 CrossRefGoogle Scholar
  21. 21.
    Kerkhoffs G, Servien E, Dunn W et al (2012) The influence of obesity on the complication rate and outcome of total knee arthroplasty. J Bone Joint Surg 94:1839–1844CrossRefGoogle Scholar
  22. 22.
    RIPO (2012) The Emilia - Romagna Register, annual report. Istituto Ortopedico Rizzoli, BolognaGoogle Scholar
  23. 23.
    RIPO (2010) Register of the Orthopaedic Prosthetic Implants. https://ripo.cineca.it/. Accessed 6 Nov 2018
  24. 24.
    RIPO (2018) Annual Report 2016Google Scholar
  25. 25.
    Biener A, Cawley J, Meyerhoefer C (2018) Reviews the impact of obesity on medical care costs and labor market outcomes in the US. Clin Chem 64:108–117.  https://doi.org/10.1373/clinchem.2017.272450 CrossRefGoogle Scholar
  26. 26.
    Risk NCD (2016) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 387:1377–1396.  https://doi.org/10.1016/S0140-6736(16)30054-X CrossRefGoogle Scholar
  27. 27.
    Kuriyama S (2006) Impact of overweight and obesity on medical care costs, all-cause mortality, and the risk of cancer in Japan. J Epidemiol 16:139–144CrossRefGoogle Scholar
  28. 28.
    Stern R, Garavaglia G, Zurcher L (2007) Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis Rheum 57:327–334.  https://doi.org/10.1002/art.22542 CrossRefGoogle Scholar
  29. 29.
    Wilson JC, Kristen Renee G, Oburu E et al (2018) Surgical site infection in overweight and obese total knee arthroplasty patients. J Orthop 15:328–332.  https://doi.org/10.1016/j.jor.2018.02.009 CrossRefGoogle Scholar
  30. 30.
    Cavaignac E, Lafontan V, Reina N et al (2013) Obesity has no adverse effect on the outcome of unicompartmental knee replacement at a minimum follow-up of seven years. Bone Joint J 95–B:1064–1068.  https://doi.org/10.1302/0301-620X.95B8.31370 CrossRefGoogle Scholar
  31. 31.
    Plate JF, Augart MA, Seyler TM et al (2017) Obesity has no effect on outcomes following unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:645–651.  https://doi.org/10.1007/s00167-015-3597-5 CrossRefGoogle Scholar
  32. 32.
    Zengerink I, Duivenvoorden T, Niesten D et al (2015) Obesity does not influence the outcome after unicompartmental knee arthroplasty (review). Acta Orthop Belg 81:776–783Google Scholar
  33. 33.
    Murray DW, Pandit H, Weston-simons JS et al (2013) The knee does body mass index affect the outcome of unicompartmental knee replacement? Knee 20:461–465.  https://doi.org/10.1016/j.knee.2012.09.017 CrossRefGoogle Scholar
  34. 34.
    Ezzati M (2016) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 387:1377–1396.  https://doi.org/10.1016/S0140-6736(16)30054-X CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Laboratorio di Tecnologia MedicaIRCCS Istituto Ortopedico RizzoliBolognaItaly

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