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Mean BMI of Overweight and Obese Patients Does Not Decrease After Successful Ankle Reconstruction
Murray John Penner, MD, FRCSC1; Hossein Pakzad, MD, FRCSC2; Alastair Younger, MB, ChB, FRSC1; Kevin John Wing, MD, FRCSC1
1 Burrard Medical Centre, 1144 Burrard Street, Vancouver, BC V6Z 2A5, Canada
2 Department of Orthopaedics, St. Paul’s Hospital, Suite 339A-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. E-mail address: hpakzad@yahoo.com
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Investigation performed at the Department of Orthopaedics, St. Paul’s Hospital, Vancouver, British Columbia, Canada

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 May 02;94(9):e57 1-7. doi: 10.2106/JBJS.K.00513
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End-stage arthritis may be associated with increased body mass index (BMI). Overweight patients with ankle arthritis often request surgery in the hope that this will allow them to initiate a weight loss program.


One hundred and forty-five overweight (BMI = 25.1 to 29.9 kg/m2) or obese (BMI > 30 kg/m2) patients who had successful ankle replacement or ankle fusion, as defined by the absence of revision ankle surgery and a postoperative improvement in the Ankle Osteoarthritis Scale (AOS) score, were identified in a retrospective cohort ankle database. Their BMIs at six months and one, two, and five years postoperatively were compared with their preoperative BMI as the primary outcome measure. Linear regression analysis was used to correlate the outcome scores against BMI with time.


No significant change in the mean BMI, compared with the preoperative BMI, was found at six months or one, two, or five years postoperatively, despite significant improvement in the AOS and Short Form-36 (SF-36) Physical Component Summary scores at all time points. The factor that most strongly correlated with postoperative BMI was preoperative BMI.


Pain and disability are significantly reduced in overweight and obese patients after successful ankle replacement or fusion. Despite this, the mean BMI remains unchanged after the surgery, indicating that weight loss does not commonly occur following successful ankle reconstruction in this patient population. Obesity is likely attributable to factors other than limited mobility caused by ankle arthritis.

Level of Evidence: 

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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