Outcomes of Total Knee Arthroplasty Revisions in Obese and Morbidly Obese Patient Populations. 2023

William R Bigham, and Gabriel S Lensing, and Murphy M Walters, and Eldrin Bhanat, and James A Keeney, and Benjamin M Stronach
Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi.

The obese population is at higher risk for complications following primary total knee arthroplasty (TKA), but little data is available regarding revision outcomes. This study aimed to investigate the role of body mass index (BMI) in the cause for revision TKA and whether BMI classification is predictive of outcomes. A multi-institutional database was generated, including revision TKAs from 2012 to 2019. Data collection included demographics, comorbidities, surgery types (primary revision, repeat revision), reasons for revision, lengths of hospital stay, and surgical times. Patients were compared using 3 BMI categories: nonobese (18.5 to 29.9), obese (30 to 39.9), and morbidly obese (≥40). Categorical and continuous variables were analyzed using chi-square and 1-way analysis of variance tests, respectively. Regression analyses were used to compare reasons for revision among weight classes. Obese and morbidly obese patients showed significant risk for repeat revision surgery in comparison to normal weight patients. Obese patients were at higher risk for primary revision due to stiffness/fibrosis and repeat revision due to malposition. In comparison to the obese population, morbidly obese patients were more likely to require primary revision for dislocation and implant loosening. Significant differences in primary and repeat revision etiologies exist among weight classes. Furthermore, obese and morbidly obese patients have a greater risk of requiring repeat revision surgery. These patients should be informed of their risk for multiple operations, and surgeons should be aware of the differences in revision etiologies when anticipating complications following primary TKA.

UI MeSH Term Description Entries
D009767 Obesity, Morbid The condition of weighing two, three, or more times the ideal weight, so called because it is associated with many serious and life-threatening disorders. In the BODY MASS INDEX, morbid obesity is defined as having a BMI greater than 40.0 kg/m2. Morbid Obesity,Obesity, Severe,Morbid Obesities,Obesities, Morbid,Obesities, Severe,Severe Obesities,Severe Obesity
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D012086 Reoperation A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery. Revision, Joint,Revision, Surgical,Surgery, Repeat,Surgical Revision,Repeat Surgery,Revision Surgery,Joint Revision,Revision Surgeries,Surgery, Revision
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D015897 Comorbidity The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.
D015992 Body Mass Index An indicator of body density as determined by the relationship of BODY WEIGHT to BODY HEIGHT. BMI Quetelet Index,Quetelet's Index,Index, Body Mass,Index, Quetelet,Quetelets Index
D019645 Arthroplasty, Replacement, Knee Replacement of the knee joint. Knee Replacement, Total,Arthroplasties, Knee Replacement,Arthroplasties, Replacement, Knee,Arthroplasty, Knee Replacement,Arthroplasty, Replacement, Partial Knee,Knee Arthroplasty,Knee Arthroplasty, Total,Knee Replacement Arthroplasties,Knee Replacement Arthroplasty,Partial Knee Arthroplasty,Partial Knee Replacement,Replacement Arthroplasties, Knee,Replacement Arthroplasty, Knee,Replacement, Total Knee,Total Knee Replacement,Unicompartmental Knee Arthroplasty,Unicompartmental Knee Replacement,Unicondylar Knee Arthroplasty,Unicondylar Knee Replacement,Arthroplasty, Knee,Arthroplasty, Partial Knee,Arthroplasty, Total Knee,Arthroplasty, Unicompartmental Knee,Arthroplasty, Unicondylar Knee,Knee Arthroplasty, Partial,Knee Arthroplasty, Unicompartmental,Knee Arthroplasty, Unicondylar,Knee Replacement, Partial,Knee Replacement, Unicompartmental,Knee Replacement, Unicondylar,Total Knee Arthroplasty

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