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No influence of obesity on survival of cementless, posterior-stabilised, rotating-platform implants

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study compares survival and outcomes in four total knee arthroplasty (TKA) populations defined by baseline body mass index (BMI). We hypothesised that there would be no difference in survival between the groups.

Materials and methods

Using an initial cohort of 1059 TKAs, BMI was systematically measured prior to surgery. A retrospective study was conducted and patients were accordingly allocated to four groups: normal or underweight (BMI < 25; n = 111), overweight (25 ≤ BMI < 30; n = 417), moderately obese (30 ≤ BMI < 35; n = 330) and severely or morbidly obese (BMI ≥ 35; n = 201). The pre- and postoperative clinical and radiographical profiles of the four groups were compared, along with any postoperative complications and the survival of each group. The minimum follow-up was 24 months. All implants had an ultra-congruent cementless posterior-stabilised rotating-platform design (Amplitude®). The primary endpoint was implant survival using Kaplan–Meier analysis. Statistical analysis was conducted using Chi-squared and Kruskal–Wallis H tests to compare the data with p < 0.05.

Results

A total of 94 knees from normal weight or underweight individuals were analysed, 346 from overweight, 281 from moderately obese and 159 from severely or morbidly obese. All knees had been operated on between 2002 and 2011 with an average follow-up of 61.7 (12–146) months. A greater degree of obesity was significantly correlated with young age at intervention (p < 0.001), as well as with a low average preoperative maximum flexion angle (p < 0.001) and KSS (p < 0.001). Postoperatively, there were no significant differences between the groups in terms of patient satisfaction (p = 0.9) or mechanical axial deviation evaluated with whole-leg standing radiography (mFTA, p = 0.3; mFA, p = 0.1; mTA, p = 0.3). The greater the degree of obesity, the lower the average postoperative maximum flexion angle (p < 0.001), KSS knee score (p < 0.001) and function score (p = 0.005). There was no significant difference between the groups in terms of total rate of postoperative complications (p = 0.9) or implant revision (p = 0.9), or in terms of 10-year implant survival (p = 0.4).

Conclusions

Obesity does not affect mid-term implant survival, irrespective of BMI, but has a negative influence on functional outcomes and potential risk of postoperative complications.

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Abbreviations

TKA:

Total knee arthroplasty

BMI:

Body mass index

KSS:

Knee Society Score

ATT:

Anterior tibial tubercle

mFTA:

Mechanical femorotibial angle

mFA:

Mechanical femoral angle

mTA:

Mechanical tibial angle

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Author information

Authors and Affiliations

  1. Albert Trillat Center, Hôpital de la Croix-Rousse, Université Lyon 1, 103 grande rue de la Croix-Rousse, 69004, Lyon, France

    Romain Gaillard & Sebastien Lustig

  2. Polyclinique du Beaujolais, 120 ancienne route de Beaujeu, 69400, Arnas, France

    Thierry Gaillard

  3. Polyclinique du Val de Saône, 44 rue Ambroise Paré, 71000, Macon, France

    Stephane Denjean

Authors
  1. Romain Gaillard
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  2. Thierry Gaillard
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  3. Stephane Denjean
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  4. Sebastien Lustig
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Contributions

RG participated in the design of the study and performed the statistical analysis. TG collected data of the study. SD collected data of the study. SL conceived of the study, and participated in its design and coordination.

Corresponding author

Correspondence to Sebastien Lustig.

Ethics declarations

Conflict of interest

RG: no conflict of interest. TG: royalties from Amplitude®. SD: royalties from Amplitude®. SL: fees from Smith & Nephew® and Medacta®, research funding from Tornier-Wright® and Amplitude®.

Ethical approval

The data were collected using CliniRecord, which was approved by the CNIL (Commission Nationale de l’Informatique et des Libertés) in 2009 (No. 1355265), with permission to extend the data storage period granted in 2011, and was declared compliant with the CNIL’s reference methodology MR-003 in 2016 (No. 2007515).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Gaillard, R., Gaillard, T., Denjean, S. et al. No influence of obesity on survival of cementless, posterior-stabilised, rotating-platform implants. Arch Orthop Trauma Surg 137, 1743–1750 (2017). https://doi.org/10.1007/s00402-017-2801-0

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  • DOI: https://doi.org/10.1007/s00402-017-2801-0

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