Functional recovery after total hip/knee replacement in obese people: A systematic review.

OBJECTIVE: Several studies have investigated the influence of body mass index (BMI) on functional gain after total hip replacement (THR) or total knee replacement (TKR) in osteoarthritis, with contradictory results. This systematic literature review was conducted to ascertain whether obesity affects functional recovery after THR or TKR in the short (<1 year), medium (<3 years) and long term (>3 years). METHODS: The study was registered with PROSPERO and conducted according to the PRISMA guidelines. A systematic literature search was conducted across Medline and EMBASE databases for articles published between 1980 and 2020 that investigated patient-reported measures of functional recovery after THR and TKR in participants with osteoarthritis and obesity (defined as BMI ≥30 kg/m2). RESULTS: Twenty-six articles reporting on 68,840 persons (34,955 for THR and 33,885 for TKR) were included in the final analysis: 5 case-control studies, 21 cohort studies (9 for THR only, 10 for TKR only and 2 for both). The average minimum follow-up was 36.4 months, ranging from 6 weeks to 10 years. Most studies found significantly lower pre-operative patient-reported functional scores for participants with obesity. After THR, there was a small difference in functional recovery in favor of those without obesity in the short term (<6 months), but the difference remained below the minimal clinically important difference (MCID) threshold and disappeared in the medium and long term. After TKR, functional recovery was better for those with obesity than those without in the first year, similar until the third year, and then decreased thereafter. CONCLUSIONS: Although there is a paucity of high-quality evidence, our findings show substantial functional gains in people with obesity after total joint replacement. Functional recovery after THR or TKR does not significantly differ, or only slightly differs, between those with and without obesity, and the difference in functional gain is not clinically important. PROSPERO NUMBER: CRD42018112919.

The unicompartmental knee implant UniSpacer™: Ten-year outcomes after treatment for medial tibio-femoral osteoarthritis.

BACKGROUND: UniSpacer™ type implants were part of the therapeutic armamentarium for medial tibio-femoral osteoarthritis before they were taken off the market in 2011. UniSpacer™ is a mobile interpositional self-centring implant that replicates the shape of the meniscus. It requires no bone cuts or component fixation. The objective of this follow-up note is to provide data on the 10-year outcomes in a cohort investigated previously in a study published in 2011. This study provides a re-evaluation of implant survival 5 years after the first analysis, as well as information on patient satisfaction and functional outcomes. HYPOTHESIS: UniSpacer™ survival remains stable after 5 additional years and provides satisfactory functional outcomes. MATERIAL AND METHODS: We included the same patients operated on from 2003 to 2009, namely, with 17 UniSpacer™ implants in 16 patients. The operative technique was the same in all patients. At last follow-up, the patients attended a visit designed specifically to allow a clinical evaluation (IKS score, revision, forgotten implant) and new radiographic imaging of the treated knee. RESULTS: Mean follow-up of this retrospective study of a prospective database was 118±25 months. Of the 17 implants, 9 (53%), in 8 patients, were still in place. Six (37.5%) patients underwent early revision arthroplasty (between 6 months and 4 years). One patient was lost to follow-up and another had died. The mean global IKS knee score was 76±15 and the mean IKS function score was 80±25. The global IKS score at last follow-up was 157±39. Mean range of flexion was 119±20°. Of the 8 patients (9 implants) who still had their implants at last follow-up, 5 (56%) reported forgetting their implant. No revisions were performed between 4 and 10 years of follow-up. DISCUSSION: The ten-year survival was limited (53%). Clinical outcomes were satisfactory in the patients who still had their implants. The low cost and simplicity of insertion may make this implant a reasonable alternative for patients with contraindications to very major surgery. LEVEL OF EVIDENCE: IV.