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Obese, non-obese patients had similar absolute pain, function scores after TKA
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Patients with high BMI who underwent total knee arthroplasty experienced absolute pain and function scores similar to non-obese patients.
Researchers stratified 633 patients who underwent TKA as normal weight (19%), overweight (32%), class-I obese (27%), class-II obese (12%) and class-III obese (9%). Using a piecewise linear model, the association between BMI group and pain and function were assessed with time intervals of baseline to 3 months, 3 months to 6 months and 6 months to 12 months. At 24 months, researchers also assessed the association between BMI group and patient-reported outcomes.
Results showed worse preoperative WOMAC pain and function scores among patients with a higher BMI. However, researchers noted patients with higher BMI also had greater improvement from baseline to 3 months. All BMI groups had similar mean change in pain and function from 3 months to 6 months and from 6 months to 24 months, according to results. Researchers found similar levels of pain, function and satisfaction across all BMI groups at 24 months. – by Casey Tingle
Disclosures: Collins reports he receives grants from NIH. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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J. Ryan Martin, MD
The authors have performed an excellent study evaluating the impact of obesity on pain and functional recovery following TKA. This has been a controversial topic. Prior studies demonstrated potentially worse functional outcomes in an obese patient population that underwent TKA. In this study, class-III obesity (BMI ≥40 kg/m2) was associated with statistically significantly worse preoperative pain and functional scores. However, from 0 months to 3 months, the class-III obese cohort was noted to have greater improvement in pain and functional scores. Additionally, there were no statistically significant differences in these scores at final follow-up among the cohorts. Within the past decade, numerous studies have demonstrated significantly worse clinical outcomes for obese patient populations, including increased risks of reoperation, revision and complications. It appears possible for obese patients to achieve similar pain and functional scores as non-obese patients, but surgeons should still exercise caution in this patient population to avoid the known increased risks. Previously described methods of perioperative patient optimization and potentially delaying surgery until patients can achieve a BMI <40 kg/m2 may result in improved outcomes for obese patients considering TKA.
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