Abstract
Purpose
The body mass index (BMI) is widely recognized as a prognostic factor in multiple operations; however, the relationship between the BMI and outcomes following total knee arthroplasty (TKA) is extensively debated. We aimed to evaluate the effect of the BMI at different cutoff values on the outcomes following primary TKA.
Methods
Electronic databases (PubMed/Medline, CENTRAL, Embase and Web of Science) were systematically searched for studies investigating the association between the BMI and outcomes following primary TKA. Two investigators independently reviewed studies for eligibility, assessed the study quality using the Newcastle-Ottawa Scale and extracted the data. A meta-analysis was performed using Review Manager software.
Results
Twenty-eight articles including a total of 20,988 TKAs were identified. The postoperative Knee Society Score appeared to trend lower in obese (BMI ≥ 30 kg/m2) patients than in non-obese (BMI < 30 kg/m2) patients. The meta-analysis showed that revision with follow-up ≥5 years, any infection, superficial infection and deep vein thrombosis occurred statistically more frequently in obese patients, whereas a deep infection occurred statistically more frequently in morbidly obese (BMI ≥ 40 kg/m2) patients than in non-obese patients. No differences in aseptic loosening with follow-up ≥5 years, pulmonary embolism and perioperative mortality rates were found between obese and non-obese patients.
Conclusions
Patients with a BMI ≥ 30 kg/m2 are at a higher risk of lower functional scores and developing complications following primary TKA. It appears reasonable to encourage obese patients to lose weight before selective TKA.
Level of evidence
Prognostic study, Level III.
Similar content being viewed by others
References
Amin AK, Clayton RAE, Patton JT, Gaston M, Cook RE, Brenkel IJ (2006) Total knee replacement in morbidly obese patients: results of a prospective, matched study. J Bone Joint Surg Br 88(10):1321–1326
Amin AK, Patton JT, Cook RE, Brenkel IJ (2006) Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Br 88(3):335–340
Bellocco R, Jia C, Ye W, Lagerros YT (2010) Effects of physical activity, body mass index, waist-to-hip ratio and waist circumference on total mortality risk in the swedish national march cohort. Eur J Epidemiol 25(11):777–788
Benjamin J, Tucker T, Ballesteros P (2001) Is obesity a contraindication to bilateral total knee arthroplasties under one anesthetic? Clin Orthop Relat Res 392:190–195
Bordini B, Stea S, Cremonini S, Viceconti M, De Palma R, Toni A (2009) Relationship between obesity and early failure of total knee prostheses. BMC Musculoskelet Disord 10:29
Bourne RB, McCalden RW, MacDonald SJ, Mokete L, Guerin J (2007) Influence of patient factors on TKA outcomes at 5 to 11 years followup. Clin Orthop Relat Res 464:27–31
Chesney D, Sales J, Elton R, Brenkel IJ (2008) Infection after knee arthroplasty—a prospective study of 1509 cases. J Arthroplasty 23(3):355–359
Collins RA, Walmsley PJ, Amin AK, Brenkel IJ, Clayton RA (2012) Does obesity influence clinical outcome at nine years following total knee replacement? J Bone Joint Surg Br 94(10):1351–1355
Deshmukh RG, Hayes JH, Pinder IM (2002) Does body weight influence outcome after total knee arthroplasty? A 1-year analysis. J Arthroplasty 17(3):315–319
Dewan A, Bertolusso R, Karastinos A, Conditt M, Noble PC, Parsley BS (2009) Implant durability and knee function after total knee arthroplasty in the morbidly obese patient. J Arthroplasty 24(6 Suppl):89–94
Dowsey MM, Choong PF (2009) Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res 467(6):1577–1581
Dowsey MM, Liew D, Stoney JD, Choong PF (2010) The impact of pre-operative obesity on weight change and outcome in total knee replacement: a prospective study of 529 consecutive patients. J Bone Joint Surg Br 92(4):513–520
Ersozlu S, Akkaya T, Ozgur AF, Sahin O, Senturk I, Tandogan R (2008) Bilateral staged total knee arthroplasty in obese patients. Arch Orthop Trauma Surg 128(2):143–148
Fehring TK, Odum SM, Griffin WL, Mason JB, McCoy TH (2007) The obesity epidemic: its effect on total joint arthroplasty. J Arthroplasty 22(6 Suppl 2):71–76
Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS (2004) The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am 86-A 8:1609–1615
Foran JR, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford DS (2004) Total knee arthroplasty in obese patients: a comparison with a matched control group. J Arthroplasty 19(7):817–824
Griffin FM, Scuderi GR, Insall JN, Colizza W (1998) Total knee arthroplasty in patients who were obese with 10 years followup. Clin Orthop Relat Res 356:28–33
Hamoui N, Kantor S, Vince K, Crookes PF (2006) Long-term outcome of total knee replacement: does obesity matter? Obes Surg 16(1):35–38
Higgins JP, Green S (2011) Cochrane Handbook for systematic reviews of interventions version 5.1.0. The cochrane collaboration. http://www.cochrane-handbook.org/
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560
Issa K, Pivec R, Kapadia BH, Shah T, Harwin SF, Delanois RE, Mont MA (2013) Does obesity affect the outcomes of primary total knee arthroplasty? J Knee Surg 26(2):89–94
Jackson MP, Sexton SA, Walter WL, Walter WK, Zicat BA (2009) The impact of obesity on the mid-term outcome of cementless total knee replacement. J Bone Joint Surg Br 91(8):1044–1048
Jarvenpaa J, Kettunen J, Kroger H, Miettinen H (2010) Obesity may impair the early outcome of total knee arthroplasty. Scand J Surg 99(1):45–49
Jarvenpaa J, Kettunen J, Soininvaara T, Miettinen H, Kroger H (2012) Obesity has a negative impact on clinical outcome after total knee arthroplasty. Scand J Surg 101(3):198–203
Jiang L, Tian W, Wang Y, Rong J, Bao C, Liu Y, Zhao Y, Wang C (2012) Body mass index and susceptibility to knee osteoarthritis: a systematic review and meta-analysis. Joint Bone Spine 79(3):291–297
Kerkhoffs GMMJ, Servien E, Dunn W, Dahm D, Bramer JAM, Haverkamp D (2012) The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 94(20):1839–1844
Krushell RJ, Fingeroth RJ (2007) Primary total knee arthroplasty in morbidly obese patients: a 5-to 14-year follow-up study. J Arthroplasty 22(6 Suppl 2):77–80
Miric A, Lim M, Kahn B, Rozenthal T, Bombick D, Sculco TP (2002) Perioperative morbidity following total knee arthroplasty among obese patients. J Knee Surg 15(2):77–83
Mont MA, Mathur SK, Krackow KA, Loewy JW, Hungerford DS (1996) Cementless total knee arthroplasty in obese patients: a comparison with a matched control group. J Arthroplasty 11(2):153–156
Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 20(7 Suppl 3):46–50
Parvizi J, Trousdale RT, Sarr MG (2000) Total joint arthroplasty in patients surgically treated for morbid obesity. J Arthroplasty 15(8):1003–1008
Paulis WD, Silva S, Koes BW, van Middelkoop M (2014) Overweight and obesity are associated with musculoskeletal complaints as early as childhood: a systematic review. Obes Rev 15(1):52–67
Razak HRB, Chong HC, Tan AHC (2013) Obesity does not imply poor outcomes in Asians after total knee arthroplasty. Clin Orthop Relat Res 471(6):1957–1963
Richmond SA, Fukuchi RK, Ezzat A, Schneider K, Schneider G, Emery CA (2013) Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? a systematic review. J Orthop Sports Phys Ther 43(8):515–524
Severson EP, Singh JA, Browne JA, Trousdale RT, Sarr MG, Lewallen DG (2012) Total knee arthroplasty in morbidly obese patients treated with bariatric surgery: a comparative study. J Arthroplasty 27(9):1696–1700
Spicer DDM, Pomeroy DL, Badenhausen WE, Schaper LA, Curry JI, Suthers KE, Smith MW (2001) Body mass index as a predictor of outcome in total knee replacement. Int Orthop 25(4):246–249
Vazquez-Vela Johnson G, Worland RL, Keenan J, Norambuena N (2003) Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg Br 85(1):52–56
Walter SD, Yao X (2007) Effect sizes can be calculated for studies reporting ranges for outcome variables in systematic reviews. J Clin Epidemiol 60(8):849–852
WHO (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894:i–xii, 1–253
Workgroup of the American Association of Hip and Knee Surgeons (AAHKS) Evidence Based Committee (2013) Obesity and total joint arthroplasty: a literature based review. J Arthroplasty 28(5):714–721
Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg Am 85-A(1):1–3
Yeung E, Jackson M, Sexton S, Walter W, Zicat B (2011) The effect of obesity on the outcome of hip and knee arthroplasty. Int Orthop 35(6):929–934
Acknowledgments
This research was funded by the China Health Ministry Program (201302007). 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.
Conflict of interest
The authors declared that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Si, Hb., Zeng, Y., Shen, B. et al. The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23, 1824–1832 (2015). https://doi.org/10.1007/s00167-014-3301-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-3301-1