0
Scientific Articles   |    
Functional Outcomes After Total Shoulder Arthroplasty in Obese Patients
Xinning Li, MD1; Phillip N. Williams, MD2; Joseph T. Nguyen, MPH2; Edward V. Craig, MD, MPH2; Russell F. Warren, MD2; Lawrence V. Gulotta, MD2
1 Division of Sports Medicine and Shoulder & Elbow Surgery, Boston University School of Medicine, Boston Medical Center, 720 Harrison Avenue, Suite 808, Boston, MA 02118. E-mail address for X. Li: Xinning.li@gmail.com
2 Division of Sports Medicine and Shoulder Surgery (P.N.W., E.V.C., R.F.W., and L.V.G.) and Department of Epidemiology (J.T.N.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Investigation performed at the Division of Sports Medicine and Shoulder Surgery and the Department of Epidemiology, Hospital for Special Surgery, New York, NY



Disclosure: None 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 any aspect of this work. 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 © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Nov 06;95(21):e160 1-8. doi: 10.2106/JBJS.L.01145
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: 

Obesity is increasingly prevalent in the United States. There are several reports of outcomes in obese patients after total knee or hip replacement. The purpose of this study was to compare the functional outcomes and complications of obese patients undergoing shoulder arthroplasty with those of overweight or normal-weight patients.

Methods: 

Seventy-six patients who underwent primary total shoulder arthroplasty were grouped according to body mass index. The groups were classified as: normal, which was denoted by a body mass index of <25 kg/m2 (twenty-six patients); overweight, which was denoted by a body mass index of 25 to 29.9 kg/m2 (twenty-five patients); and obese, which was denoted by a body mass index of ≥30 kg/m2 (twenty-five patients). Preoperative demographics and perioperative and postoperative complications were recorded. The American Shoulder and Elbow Surgeons score, Short Form-36, and visual analog scale pain and fatigue scores were evaluated at baseline and at the two-year follow-up visit.

Results: 

In the normal group, the mean scores (and standard deviation) improved for the American Shoulder and Elbow Surgeons score from 38.4 ± 15.5 points preoperatively to 80.2 ± 19.4 points at two years postoperatively (p < 0.001) and for the Short Form-36 Physical Component Summary score from 38.3 ± 6.5 points preoperatively to 53.7 ± 11.3 points at two years postoperatively (p < 0.001); the visual analog scale pain scores decreased from a mean score of 62 points preoperatively to 12 points at two years postoperatively (p < 0.001). In the overweight group, the mean scores (and standard deviation) improved for the American Shoulder and Elbow Surgeons score from 37.4 ± 18.1 points preoperatively to 75.2 ± 24.9 points at two years postoperatively (p < 0.001) and for the Short Form-36 Physical Component Summary score from 36.1 ± 8.0 points preoperatively to 39.8 ± 12.2 points at two years postoperatively (p = 0.21); the visual analog scale pain scores decreased from 68 points to 18 points (p < 0.001). In the obese group, the mean scores (and standard deviation) improved for the American Shoulder and Elbow Surgeons score from 35.8 ± 12.5 points preoperatively to 80.0 ± 20.6 points at two years postoperatively (p < 0.001) and for the Short Form-36 Physical Component Summary score from 36.3 ± 8.4 points preoperatively to 40.7 ± 12.4 points at two years postoperatively (p = 0.15); the visual analog scale pain scores decreased from 66 points preoperatively to 11 points at two years postoperatively (p < 0.001). There was one deep infection in the overweight group that required surgical irrigation and debridement. Two revisions of the components were required in the normal group.

Conclusions: 

Obesity did not have a detrimental effect on the improvement of short-term shoulder function. However, the overall physical function of obese and overweight patients does not significantly improve after total shoulder arthroplasty. In the normal body mass index group, patients did improve overall physical function after total shoulder arthroplasty.

Level of Evidence: 

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

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    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.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    11/15/2013
    Louisiana - Ochsner Health System
    04/16/2014
    Georgia - Choice Care Occupational Medicine & Orthopaedics
    02/10/2014
    IL - The University of Chicago's Department of Orthopaedic Surgery and Rehabilitation Medicine