Body Composition, Strength, and Dietary Intake of Patients with Hip or Knee Osteoarthritis.

PURPOSE: To describe body composition (fat mass (FM) and fat-free mass (FFM)), strength, and nutritional characteristics of patients with hip or knee osteoarthritis undergoing total joint arthroplasty. METHODS: In this prospective pilot study, osteoarthritic patients underwent body composition assessment using bioelectrical impedance analysis, grip strength measurement, and completed a 24-h dietary recall during their pre-operative assessment. RESULTS: Fifty-five patients were included (∼66% females, age 43-89 years). Mean ± SD body mass index (BMI) was 32.79 ± 6.48 kg/m(2) and 62% were obese. Compared with hip osteoarthritis patients, knee osteoarthritis patients had a higher BMI (P = 0.018) and males with knee osteoarthritis had a lower grip strength (P = 0.028). There was a wide range in FM and FFM values across the BMI spectrum. Patients with a higher FM index (FMI, FM/height in m(2)) had higher levels of pain (P = 0.036) and females with higher FMI had a lower grip strength (P = 0.048). Dietary under-reporting was common and many patients did not meet recommendations for protein, vitamins C and E, or omega-3 fatty acids. Those who consumed less protein than the recommended dietary allowance were older (P = 0.018). CONCLUSIONS: A wide variability of body composition and dietary intake was observed which may impact strength and ultimately affect physical function. As such, patients with osteoarthritis may benefit from targeted nutrition and physical activity interventions before and after surgery.

Sarcopenic obesity and health outcomes in patients seeking weight loss treatment.

AIM: To investigate the prevalence of sarcopenic obesity (SO) and its association with health outcomes in patients seeking weight loss treatment from a bariatric center. METHODS: In this retrospective study, patients [≥18 years old, body mass index (BMI) ≥30 kg/m2] from the Tallahassee Memorial Bariatric Center and with baseline body composition assessment by bioelectrical impedance analysis were included. Fat mass index (FMI = fat mass/height2) and fat-free mass index (FFMI = fat free mass/height2) were calculated. SO was defined by a FMI/FFMI ratio greater than the 95 percentile of sex, BMI and ethnicity specific population-representative references. Medical records were reviewed for biochemical and comorbidity measures. RESULTS: One hundred and forty-four patients (∼69% females, mean age 55.6 years, mean BMI 46.6 kg/m2) were included. Patients' FMI/FFMI ratios ranged from 0.35 to 1.60 kg/m2 across body weight spectrum, with 51% having SO. Blood pressure, fasting glucose, triglycerides, HDL or LDL were not different between patients with and without SO. However, the prevalence of high cholesterol, asthma, alcoholism and hernia were higher in patients with SO. SO was the strongest univariate predictor of high cholesterol (OR = 2.08, 95% CI 1.07-4.04) and asthma (OR = 2.77, 95% CI = 1.12-6.83). CONCLUSION: SO was prevalent and associated with adverse health outcomes, beyond that captured by anthropometric measures in the present study.

The combined use of simulation and navigation to demonstrate hip kinematics.

Computer navigation of total hip arthroplasty and computer simulation of hip motions based on collision detection were both introduced more than ten years ago. Neither of these promising technologies has achieved its full potential to improve patient outcomes. Combining these two technologies allows the individual strengths of each to more easily demonstrate hip kinematics in a clinically useful way. All normal and pathologic combined hip motions must be clearly and accurately reported to fully evaluate the kinematics involved in total hip arthroplasty, femoroacetabular impingement syndrome, and other hip disorders. The use of three-dimensional data graphs allows for a rapid and thorough evaluation of the very large data sets that are required for the purpose of making a complete report of all combined hip motions. Data can be obtained from simulations made with use of high-resolution computed tomographic scans and computer-aided implant-design files or from clinically obtained motion analysis on fresh cadavers or normal subjects. The use of these methods and graphics allows for the thorough evaluation of the geometries of current implant designs and will help improve future implant designs. The pathologic structures in hips with femoroacetabular impingement can be modeled in three dimensions, and surgical treatment plans can be developed to provide impingement-free normal hip motion without excessive osseous resection. The combination of these technologies provides hope for the improved surgical placement of total hip implants by providing the basis for a kinematic, impingement-based total hip navigation system.