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Influence of body mass index on revision rates after primary total knee arthroplasty

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Abstract

Purpose

Studies demonstrate that revision rates after primary total knee arthroplasty (TKA) tend to be higher in obese patients. However, the existence of a body mass index (BMI) threshold remains unexplored.

Methods

We conducted a prospective cohort study of 2442 primary TKAs in 2035 patients (69.1 % women; mean age 72 years; mean follow-up 93 months, range 38–203). We evaluated the influence of BMI in five categories on all-cause revision after TKA using incidence rates (IR), hazard ratios (HR), and Kaplan–Meier survival analysis. Adjustment for baseline imbalances was performed using Cox regression analysis.

Results

Over the study period, 71 revisions occurred. Revision rates were 3.2 cases/1000 patient-years for patients of normal weight, 3.4/1000 for overweight patients and 3.0/1000 for patients classified as obese class I. At BMI ≥ 35, a significant increase in revision was noted. Comparing BMI ≥ 35 vs. < 35, there were 6.4 vs. 3.2 /1000. Crude HR was 2.0 [95 % confidence interval (CI) 1.2–3.3, p = 0.009], and the adjusted HR was 2.1 (95 % CI 1.2–3.6, p = 0.008).

Conclusion

All-cause revision rates after primary TKA doubled in patients with a BMI of 35 but were similar in those with a BMI <35.

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Acknowledgments

The authors thank all the orthopaedic surgeons from the Division of Orthopaedic Surgery and Traumatology who provided information to the knee arthroplasty registry since 1998, as well as Carole Bandi, Flavia Renevey, Lamia Blatter-Sellak, Johanna Duss and Christophe Baréa for their invaluable help with data management and data entry.

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Authors and Affiliations

  1. Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211, Genève 14, Switzerland

    Matthieu Zingg, Hermès H. Miozzari, Daniel Fritschy, Pierre Hoffmeyer & Anne Lübbeke

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  1. Matthieu Zingg
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  2. Hermès H. Miozzari
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  3. Daniel Fritschy
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  4. Pierre Hoffmeyer
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Correspondence to Matthieu Zingg.

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Funding information

The Division of Orthopaedic Surgery received financial institutional support from the Fondation pour la recherche ostéo-articulaire for the knee arthroplasty registry. The funding source had no role in data collection, analysis,or interpretation in the manuscript preparation or its submission for publication. There were no other financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Zingg, M., Miozzari, H.H., Fritschy, D. et al. Influence of body mass index on revision rates after primary total knee arthroplasty. International Orthopaedics (SICOT) 40, 723–729 (2016). https://doi.org/10.1007/s00264-015-3031-0

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  • DOI: https://doi.org/10.1007/s00264-015-3031-0

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