Long-term results after weight loss intervention in knee arthroplasty patients with obesity.

INTRODUCTION: Obesity is a well-known problem in patients undergoing total knee arthroplasty (TKA). We have previously shown that it is feasible and safe to implement an intensive weight loss programme shortly before TKA. Preoperatively, the programme produced an average weight loss of 10.7 kg while also improving body composition and reducing cardiovascular risk factors. One year after TKA, the patients in the weight loss programme managed to maintain their weight loss, whereas no change was observed in the control group. Both groups showed major improvements in health-related quality of life (QoL) and knee function. The aim of this study was to investigate the long-term effect of a weight loss intervention in patients with obesity undergoing TKA. METHODS: This was a seven-year follow-up study from a randomized controlled trial. Body weight, blood pressure and waist circumference were measured. Additionally, data on patient-reported outcome, range of knee motion (ROM), hypertension and diabetes status were collected. RESULTS: Forty-nine patients were examined at the follow-up. No differences were found between the intervention and the control group on body weight, hypertension, diabetes, waist circumference or knee ROM. The intervention group had increased their mean weight significantly more than the control group (difference = 3.1, 95% confidence interval: 1.3-4.8). 66% had hypertension and 38% had Type 2 diabetes. Pain, function and QoL were improved for both groups. CONCLUSION: The patients in the intervention group were unable to maintain their preoperative weight loss when measured seven year after TKA. FUNDING: none. TRAIL REGISTRATION. not relevant.

Is high body mass index a potential risk factor for poor outcome after hip arthroplasty? A cohort study of 98 patients 1 year after surgery.

The association between obesity and outcome after hip arthroplasty is controversial. We investigated whether there was an association between the preoperative body mass index in primary total hip arthroplasty patients and their quality of life and physical function 1 year after surgery. 98 patients were included in the study. The results were adjusted for age, sex, and comorbidities. The obese group had an increased risk of obtaining a worse physical score and a lower activity in daily living score at the 1-year follow-up than compared with the normal-weight group. In addition, the obese patients' hospitalization was 1 day longer than that of the normal-weight patients. However, the overweight patients accomplished the largest improvement of general health and hip-related health compared with the normal-weight group.

The Association Between Preoperative Symptoms of Obesity in Knee and Hip Joints and the Change in Quality of Life After Laparoscopic Roux-en-Y Gastric Bypass.

BACKGROUND: Weight loss after bariatric surgery is shown to reduce knee and hip pain in the majority of the severely obese. Studies indicate that with a reduction in musculoskeletal symptoms, quality of life (QoL) will improve. The group of severely obese with knee and hip symptoms might therefore have potential for a large improvement in QoL after a bariatric surgery. This study aimed therefore to assess the association between the degree of knee and hip symptoms before a laparoscopic Roux-en-Y gastric bypass (LRYGB) and the improvement of QoL, 1 year after the surgery, in severely obese. METHODS: This study is a historical cohort study based on data collected consecutively at the private hospital Mølholm, Denmark. Before LRYGB surgery, 4548 severely obese completed a questionnaire on knee and hip symptoms of obesity and QoL. One year after surgery, 2862 (62.9 %) of the participants answered the same questionnaire again. RESULTS: Participants with moderate or severe knee or hip symptoms, before the surgery, experienced a statistically significantly larger improvement of their QoL, compared to participants without symptoms before the surgery. Furthermore, an association between the reduction of knee and hip symptoms and the improvement in QoL was found. CONCLUSIONS: Severely obese with moderate or severe preoperative knee and hip symptoms experienced a larger improvement of their QoL after a LRYGB compared to participants without symptoms before the operation.

No correlations between radiological angles and self-assessed quality of life in patients with hip dysplasia at 2-13 years of follow-up after periacetabular osteotomy.

BACKGROUND: Only few studies have described patients' health-related quality of life (QoL) after periacetabular osteotomy (PAO). Thus, there is a lack of data on the self-assessed outcome of patients operated with PAO, and none of the existing studies correlate the results from Medical Outcomes Short Form-36 questionnaire (SF-36) with the radiological parameters. PURPOSE: To investigate the health-related QoL for patients with hip dysplasia operated with PAO and to investigate whether QoL is associated with the acetabular angles or hypermobility. MATERIAL AND METHODS: Out of 388 patients, 228 patients (mean age, 40.5 years; mean follow-up, 7.1 years) returned the SF-36 and Beighton questionnaires. The patient's QoL was compared to reference data from a Danish population. Center-edge (CE) and acetabular index (AI) angles were measured before and after PAO and the association with the patients' QoL was tested with logistic regression. RESULTS: For both men and women the postoperative SF-36 score was significantly lower than for the reference data for a Danish population, especially for those dimensions concerning physical health. No association was found between the patients' CE or AI angles before or after PAO and their subsequent QoL. Significant associations were found between both Physical Component Score (PCS) and physical function (PF) and follow-up time after the operation. The adjusted OR for a PCS ≥ 50 was 0.87 (95% CI 0.76-0.99) and for a PF ≥ 85 0.81 (95% CI 0.71-0.91). No association between hyper mobility and PCS, PF, or bodily pain (BP) was found. CONCLUSION: The physical components of QoL in patients undergoing PAO are significantly lower than the Danish population used as reference. Furthermore, the results suggest that physical function after PAO decreases with longer follow-up time. Neither the acetabular angles nor hypermobility is associated with the physical components of QoL.

Overweight preoperatively impairs clinical outcome after knee arthroplasty: a cohort study of 197 patients 3­5 years after surgery.

BACKGROUND: Obesity contributes much to the development of knee osteoarthritis. However, the association between obesity and outcome after knee replacement is controversial. We investigated whether there was an association between the preoperative body mass index (BMI) of patients who underwent total knee arthroplasty (TKA) and their quality of life (QoL) and physical function 3-5 years after surgery. METHODS: 197 patients who had undergone primary TKA participated in a 3-5 year follow-up study. The outcome measures were the patient-reported Short Form 36 (SF-36) and the American Knee Society score (KSS). RESULTS: Ordinal logistic regression analysis (adjusted for age, sex, disease, and surgical approach) revealed a statistically significant correlation between BMI and 9 of the 14 outcome measures. For all outcome measures, we found an odds ratio (OR) of < 1. A difference in BMI of 1 kg/m(2) increased the risk of a lower score from a minimum of 2% (OR = 0.98 (0.93-1.03); p = 0.5) (Mental Component score) to a maximum of 13% (OR = 0.87 (0.82-0.93); p < 0.001) (KSS function score). INTERPRETATION: Our findings indicate that TKA patients' preoperative BMI is a predictor of the clinical effect and patients' quality of life 3-5 years postoperatively. A high BMI increases the risk of poor QoL (SF-36) and physical function (KSS).