Relationship between obesity and early failure of total knee prostheses
Tóm tắt
Obesity is a risk factor for knee arthritis. Total knee arthroplasty is the definitive surgical treatment of this disease. Therefore, a high percentage of subjects treated are overweight. Since 2000 in the Emilia-Romagna Region the Register of Orthopedic Prosthetic Implantology, RIPO, has recorded data of all the primary and revision operations performed on the knee; height and weight of patients at the time of surgery have also been recorded. To understand how overweight and obesity affect the outcome of knee arthroplasty, a population of subjects treated with cemented total knee arthroplasty between 2000 and 2005 was studied. 9735 knee prostheses were implanted in 8892 patients; 18.9% of the patients were normal weight, 48.2% were overweight (25 < Body Mass Index <= 30), 31.1% were obese (30 < BMI <= 40), and 1.8% were morbidly obese (BMI > 40). Mean and range of follow-up were respectively 3.1 and 1.5–6 yrs. Implant failure was defined as the exchange of at least one component for whatever reason. In normal weight patients there were 36 failures out of 1840 implants (1.96%), in overweight patients there were 87 out of 4692 (1.85%), in obese 59 out of 3031 (1.94%), and in morbidly obese there were 4 out of 172 (2.3%). The mean time to failure for each class was 1.57, 1.48, 1.60, 1.77 yrs. Cox regression analyses showed that the risk of implant failure was not influenced by BMI, absolute body weight, or sex. Conversely, an increased failure risk was observed in mobile meniscus prostheses in comparison with those with a fixed meniscus (Rate Ratio 1.88); an increased failure risk was also related to age (Rate Ratio 1.05 per year). These results were also confirmed when considering septic loosening as the end-point. There were no differences in the rate of perioperative complications and death in the 4 classes of BMI. In conclusion, cemented knee prostheses, implanted in patients with arthritis do not have significantly different rates of survival or perioperative complications in obese subjects compared with normal weight subjects, at least up to 5 years after surgery. The conclusion also applies to subjects affected by morbid obesity, altough this findings should be regarded with caution due to the small sample examined.
Tài liệu tham khảo
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM: Prevalence of overweight and obesity in the United States. 1999–2004. JAMA. 2006, 295 (13): 1549-1555. 10.1001/jama.295.13.1549.
Andreyeva T, Michaud PC, van Soest A: Obesity and health in Europeans aged 50 years and older. Public Health. 2007, 121 (7): 497-509. 10.1016/j.puhe.2006.11.016.
Nafziger AN, Stenlund H, Wall S, Jenkins PL, Lundberg V, Pearson TA, Weinehall L: High obesity incidence in northern Sweden: how will Sweden look by 2009?. Eur J Epidemiol. 2006, 21 (5): 377-382. 10.1007/s10654-006-9001-5.
Nafziger AN, Lindvall K, Norberg M, Stenlund H, Wall S, Jenkins PL, Pearson TA, Weinehall L: Who is maintaining weight in a middle-aged population in Sweden? A longitudinal analysis over 10 years. BMC Public Health. 2007, 127: 108-118. 10.1186/1471-2458-7-108.
Droyvold WB, Nilsen TI, Kruger O, Holmen TL, Krokstad S, Midthjell K, Holmen J: Change in height, weight and body mass index: Longitudinal data from the HUNT Study in Norway. Int J Obes. 2006, 30 (6): 935-939. 10.1038/sj.ijo.0803178.
Moon G, Quarendon G, Barnard S, Twigg L, Blyth B: Fat nation: Deciphering the distinctive geographies of obesity in England. Soc Sci Med. 2007, 65 (1): 20-31. 10.1016/j.socscimed.2007.02.046.
Brown A, Siahpush M: Risk factors for overweight and obesity: results from the 2001 National Health Survey. Public Health. 2007, 121 (8): 603-613. 10.1016/j.puhe.2007.01.008.
World Health Organization: Regional Office for Europe. European health for all statistical database. [http://www.euro.who.int/hfadb]
Dieppe PA, Lohmander SL: Pathogenesis and management of pain in osteoarthritis. The Lancet. 2005, 365: 965-973. 10.1016/S0140-6736(05)71086-2.
Wendelboe AM, Hegmann KT, Biggs JJ, Cox CM, Portmann AJ, Gildea JH, Gren LH, Lyon JL: Relationships between body mass indices and surgical replacements of knee and hip joints. Am J Prev Med. 2003, 25 (4): 290-295. 10.1016/S0749-3797(03)00218-6.
Oliveria SA, Felson DT, Cirillo PA, Reed JI, Walker AM: Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee. Epidemiologia. 1999, 10: 161-166.
Sahyoun NR, Hochberg MC, Helmick CG, Harris T, Pamuk ER: Body mass index, weight change, and incidence of self-reported, physician-diagnose arthritis among women. Am J Pub Health. 1999, 89: 391-394. 10.2105/AJPH.89.3.391.
Jain NB, Higgins LD, Ozumba D, Guller U, Cronin M, Pietrobon R, Katz JN: Trends in epidemiology of knee arthroplasty in the United States, 1990–2000. Arthritis Rheum. 2005, 52 (12): 3928-3933. 10.1002/art.21420.
Swedish Knee Arthroplasty Register. 2006, [http://www.knee.nko.se]
The Norvegian Arthroplasy Register. 2006, [http://www.haukeland.no]
The Finish Arthroplasty Registry. 2004, [http://www.nam.fi/english/publications/]
Australian Orthopaedic Association National Joint Replacement Registry. 2006, [http://www.dmac.adelaide.edu.au/aoanjrr/index.jsp]
NIH Consensus Development Conference on Total Knee Replacement. National Institutes of Health Consensus Development Conference Statement. 2003
Stea S, Bordini B, De Clerico M, Petropulacos K, Toni A: First hip arthroplasty register in Italy: 55,000 cases and 7 year follow-up. Int Orthop. 2007,
Coombes R: Rationing of joint replacements raises fears of further cuts. BMJ. 2005, 331: 1290-10.1136/bmj.331.7528.1290.
Register of the Orthopaedic Prosthetic Implants. Emilia Romagna, Italy, [https://ripo.cineca.it/Reports.html]
Cox DR: Regression Models and Life Tables. Royal Statistical Society. 1972, 34: 187-220.
Huang CH, Ho FY, Ma HM, Yang CT, Liau JJ, Kao HC, Young TH, Cheng CK: Particle size and morphology of UHMWPE wear debris in failed total knee arthroplasties – a comparison between mobile bearing and fixed bearing knees. J Orthop Res. 2002, 20: 1038-1041. 10.1016/S0736-0266(02)00015-3.
Gillespie GN, Porteous AJ: Obesity and knee arthroplasty. Knee. 2007, 14 (2): 81-86. 10.1016/j.knee.2006.11.004.
Amin AK, Patton JT, Cook RE, Brenkel IJ: Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis?. J Bone Joint Surg Br. 2006, 88 (3): 335-340. 10.1302/0301-620X.88B3.16488.
Spicer DD, Pomeroy DL, Badenhausen WE, Schaper LA, Curry JI, Suthers KE, Smith MW: Body mass index as a predictor of outcome in total knee replacement. Int Orthop. 2001, 25 (4): 246-249. 10.1007/s002640100255.
Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS: The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am. 2004, 86-A (8): 1609-1615.
Faraj AA, Nevelos AB, Nair A: A 4- to 10-year follow-up study of the Tricon-M noncemented total knee replacement. Orthopedics. 2001, 24 (12): 1151-1154.
Griffin FM, Scuderi GR, Insall JN, Colizza W: Total knee arthroplasty in patients who were obese with 10 years followup. Clin Orthop Relat Res. 1998, 356: 28-33. 10.1097/00003086-199811000-00006.
Hamoui N, Kantor S, Vince K, Crookes PF: Long-term outcome of total knee replacement: does obesity matter?. Obes Surg. 2006, 16 (1): 35-38. 10.1381/096089206775222140.
Foran JR, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford DS: Total knee arthroplasty in obese patients: a comparison with a matched control group. J Arthroplasty. 2004, 19 (7): 817-824. 10.1016/j.arth.2004.03.017.
Vasquez-Vela Johnson G, Worland RL, Keenan N, Norambuena N: Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg. 2003, 85-B: 52-56. 10.1302/0301-620X.85B1.12992.
Miric A, Lim M, Kahn B, Rozenthal T, Bombick D, Sculco TP: Perioperative morbidity following total knee arthroplasty among obese patients. J Knee Surg. 2002, 15 (2): 77-83.
Krushell RJ, Fingeroth RJ: Primary Total Knee Arthroplasty in Morbidly Obese Patients: a 5- to 14-year follow-up study. J Arthroplasty. 2007, 22 (6 Suppl 2): 77-80. 10.1016/j.arth.2007.03.024.
Amin AK, Clayton RA, Patton JT, Gaston M, Cook RE, Brenkel IJ: Total knee replacement in morbidly obese patients. Results of a prospective, matched study. J Bone Joint Surg Br. 2006, 88 (10): 1321-1326. 10.1302/0301-620X.88B10.17697.
Winiarsky R, Barth P, Lotke P: Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am. 1998, 80 (12): 1770-1774.
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