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Is Morbid Obesity a Modifiable Risk Factor in Patients Who Have Severe Knee Osteoarthritis and do Not Have a Formal Perioperative Optimization Program?
Botros, Mina; Guirguis, Paul; Balkissoon, Rishi; Myers, Thomas G; Thirukumaran, Caroline P; Ricciardi, Benjamin F.
Afiliación
  • Botros M; Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York.
  • Guirguis P; Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York.
  • Balkissoon R; Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York.
  • Myers TG; Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York.
  • Thirukumaran CP; Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York; Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York.
  • Ricciardi BF; Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York; Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York.
J Arthroplasty ; 39(3): 658-664, 2024 Mar.
Article en En | MEDLINE | ID: mdl-37717836
BACKGROUND: Obesity is considered a modifiable risk factor prior to total knee arthroplasty (TKA); however, little data support this hypothesis. Our purpose was to evaluate patients who have a body mass index (BMI) >40 presenting for TKA to determine the incidence of: (1) patients who achieved successful weight loss through nutritional modification or bariatric surgery and (2) patients who underwent TKA over the study period without the presence of a formal optimization program. METHODS: This was a retrospective, single-center analysis. Inclusion criteria included: Kellgren and Lawrence grade 3 or 4 knee osteoarthritis, BMI >40 at presentation, and minimum 1-year follow-up (mean 45 months) (N = 624 patients). Demographics, weight loss interventions, pursuit of TKA, maximum BMI change, and Patient-Reported Outcomes Measurement Information System scores were collected. Multivariable logistic and linear regressions evaluated associations of underlying demographic and treatment characteristics with outcomes. RESULTS: There were 11% of patients who ended up pursuing TKA over the study period. Bariatric surgery was 3.7 times more likely to decrease BMI by minimum 10 compared to nonsurgical intervention (95% confidence interval [CI] [1.7, 8.1]; P = .001). Bariatric surgery resulted in mean BMI change of -3.3 (range, 0 to 22) compared to nonsurgical interventions (-2.6 [range, 0 to 12]) and no intervention (0.4 [range, 0 to 15]; P < .0001). Bariatric surgery patients were 3.1 times more likely to undergo TKA (95% CI [1.3, 7.1]; P = .008), and nonsurgical interventions were 2.4 times more likely to undergo TKA (95% CI [1.3, 4.5]; P = .006) compared to no intervention. Non-White patients across all interventions were less likely to experience loss >5 BMI compared to White patients (95% CI [0.2, 0.9]; P = .018). CONCLUSIONS: Most patients were unable to reduce BMI more than 5 to 10 over a mean 4-year period without a formal weight optimization program. Utilization of bariatric surgery was most successful compared to nonsurgical interventions, although ultimate pursuit of TKA remained low in all cohorts.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Obesidad Mórbida / Osteoartritis de la Rodilla Tipo de estudio: Etiology_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Arthroplasty Asunto de la revista: ORTOPEDIA Año: 2024 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Obesidad Mórbida / Osteoartritis de la Rodilla Tipo de estudio: Etiology_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Arthroplasty Asunto de la revista: ORTOPEDIA Año: 2024 Tipo del documento: Article