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Scientific Articles   |    
The Influence of Obesity on the Complication Rate and Outcome of Total Knee ArthroplastyA Meta-Analysis and Systematic Literature Review
Gino M.M.J. Kerkhoffs, MD, PhD1; Elvire Servien, MD, PhD2; Warren Dunn, MD, MPH3; Diane Dahm, MD4; Jos A.M. Bramer, MD, PhD1; Daniel Haverkamp, MD, PhD1
1 Department of Orthopedic Surgery, Orthotrauma Research Center Amsterdam, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail address for G.M.M.J. Kerkhoffs: g.m.kerkhoffs@amc.nl
2 Centre Albert Trillat, Hôpital de la Croix-Rousse, Groupement Hospitalier Nord, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France
3 Department of Orthopaedic Surgery, Vanderbilt Orthopaedic Institute, 1215 21st Avenue South, Suite 4200, Nashville, TN 37232
4 Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
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  • Disclosure statement for author(s): PDF

Investigation performed at the Department of Orthopedic Surgery, Orthotrauma Research Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands



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 Oct 17;94(20):1839-1844. doi: 10.2106/JBJS.K.00820
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Abstract

Background: 

The increase in the number of individuals with an unhealthily high body weight is particularly relevant in the United States. Obesity (body mass index ≥30 kg/m2) is a well-documented risk factor for the development of osteoarthritis. Furthermore, an increased prevalence of total knee arthroplasty in obese individuals has been observed in the last decades. The primary aim of this systematic literature review was to determine whether obesity has a negative influence on outcome after primary total knee arthroplasty.

Methods: 

A search of the literature was performed, and studies comparing the outcome of total knee arthroplasty in different weight groups were included. The methodology of the included studies was scored according to the Cochrane guidelines. Data extraction and pooling were performed. The weighted mean difference for continuous data and the weighted odds ratio for dichotomous variables were calculated. Heterogeneity was calculated with use of the I2 statistic.

Results: 

After consensus was reached, twenty studies were included in the data analysis. The presence of any infection was reported in fourteen studies including 15,276 patients (I2, 26%). Overall, infection occurred more often in obese patients, with an odds ratio of 1.90 (95% confidence interval [CI], 1.46 to 2.47). Deep infection requiring surgical debridement was reported in nine studies including 5061 patients (I2, 0%). Deep infection occurred more often in obese patients, with an odds ratio of 2.38 (95% CI, 1.28 to 4.55). Revision of the total knee arthroplasty, defined as exchange or removal of the components for any reason, was documented in eleven studies including 12,101 patients (I2, 25%). Revision for any reason occurred more often in obese patients, with an odds ratio of 1.30 (95% CI, 1.02 to 1.67).

Conclusions: 

Obesity had a negative influence on outcome after total knee arthroplasty.

Level of Evidence: 

Prognostic Level II. 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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