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Elevated BMI correlated with need for early revision TKA for infection
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Recent data has revealed that an elevated BMI is a risk factor for early referral for revision total knee arthroplasty.
Researchers retrospectively reviewed 666 revision total knee arthroplasties (TKAs) in 642 patients. Investigators identified age, sex, indication for revision TKA, preoperative BMI and time from primary TKA to revision TKA.
Results showed the mean time between the primary TKA and revision TKA was 5 years. Investigators noted an increase in BMI affected the mean time to revision TKA. According to the study abstract, the percent of referred revision TKAs performed by 5 years was 54% for a normal BMI patient, 64% an overweight patient, 71% for an obese class I patient, 68% for an obese class II patient and 73% for a morbidly obese patient.
According to researchers, the difference in time to revision TKA between patients with normal BMI and those with an elevated BMI was significant. A significant increase was seen in early revision TKA due to infection in patients with an elevated BMI vs. those with normal BMI. Acute revision TKA, early revision TKA, midterm TKA and late revision TKA for aseptic loosening and/or osteolysis, instability, stiffness or other causes were not significantly increased amongst patients with a normal BMI and patients with an elevated BMI. ‒ by Monica Jaramillo
Disclosures: Electricwala reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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Robert S. Namba, MD
In the study entitled “Elevated body mass index is associated with early total knee revision for infection,” the authors evaluated 666 failed, primary total knee arthroplasty procedures referred to a tertiary care center for revision surgery. The patients were stratified according to BMI, reason for revision and time to revision. Obesity was observed to be associated with an increased rate of early revisions and an increased risk of revision for infection.
While this study adds to the increasing body of literature that obesity confers an increased risk of complications, some caution is warranted in interpreting these findings. The patient populations were not described, leading to potential confounders in the analysis. For example, it is possible the high BMI patient subgroups had more comorbidities, such as diabetes mellitus, increasing the risk of infection independent of BMI. Referrals to tertiary care medical centers can be associated with selection bias in that easier revision cases may be managed in the community, but more difficult cases, including obese patients, are preferentially referred to academic centers. Increased operative time, often used as a surrogate for surgical complexity, has been described as a risk factor for infection.
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