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Study suggests TKA is reasonable in selected obese patients
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CHICAGO — Obese patients received as much benefit from total knee replacement at 9 years as nonobese patients, according to a study conducted by Scottish researchers presented at the American Academy of Orthopaedic Surgeons Annual meeting.
“Obese patients do receive great benefit from total knee replacement,” Robert A. Clayton, MB, ChB, said during his presentation. “Nonobese patients had slightly better scores. The highly obese group did have a higher complication rate, but the failure rates in both groups were similar. We do not believe it is reasonable to withhold total knee replacement for a patient with a body mass index below 40.”
Clayton and colleagues conducted a retrospective study of 445 patients who underwent primary total knee arthroplasty (TKA) and followed up with them at 6 months, 18 months, 36 months, 60 months and 108 months. They grouped patients body mass index (BMI), categorizing those with a BMI <30 as nonobese and those with a BMI >30 as obese. They further subdivided the obese group into patients with a BMI between 30 and 35 and those with a BMI >35. They measured outcomes using American Knee Society (AKS) knee and function scores.
Robert A. Clayton
AKS outcome scores increased for all patients at each follow-up time. Overall, the revision rate was 2.2%. The AKS score increased from 31.9 to 87.7 at 9 years for nonobese patients and from 30.2 to 82.2 in obese patients. The obese patients showed more complications than nonobese patients, and highly obese patients had lower AKS scores at each follow-up time.
“The funding authorities (in the United Kingdom) started to question whether they should be funding patients to have surgery if they have a high body mass index,” Clayton said. “You may be facing the same problem [in the United States].”
Reference:
Clayton R. Paper #430. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 19-23, 2013; Chicago.
Disclosure: Clayton has no relevant financial disclosures.