In a study by Gino M.M.J. Kerkhoffs, MD, PhD, from the Department ofOrthopedic Surgery, Orthotrauma Research Center Amsterdam, University of Amsterdam, the Netherlands and his colleagues, about obesity as a well known risk factor fortotal knee arthroplasty. The rates of obesity and total knee arthroplasty have increased with the increasing prevalence of obesity. It is not clear whether obesity itself is a risk factor for poor outcomes following total knee arthroplasty. Differing results have been reported for complications and revision rates among obese or nonobese patients who have undergone total knee arthroplasty.
This is a study examining outcomes after total knee arthroplasty to determine if obesity contributes to poorer short-term and long-term outcomes.
According to a meta-analysis published in the October 17, 2012 issue of the Journal of Bone and Joint Surgery obese patients are more than 2 times likely to incur deep infection, nearly twice as likely to incur infection after a total knee replacement, and somewhat more likely to require a surgical revision than those who are not obese.
The surgical outcomes for total knee arthroplasty among those with a body mass index (BMI) of 30 kg/m2 or more were surveyed together with outcomes for patients with BMIs lower than 30 kg/m2.
The authors found that obesity was a persistent risk factor for infection.
According to Marc DeHart, MD, from Texas Orthopedic in Austin and a clinical assistant professor at Texas A&M Health Science Center in Bryan, as told to Medscape Medical News “The study is the highest level of science that we have in orthopedics. Dr. DeHart was not associated with the study and stated “It’s hard to do a blinded study, and that’s the only study that would be better.”
Although specific studies that looked at knee replacement outcomes with obese and nonobese patients have shown mixed results, with some showing no difference between the two patient groups and others that reported higher levels of complications, Dr. DeHart said the current research confirms what most orthopaedic surgeons have noticed in their practices.
Orthopedic surgeons understand people who are heavier are harder to operate on and also have other issues related to their health. It takes longer to do cases, it’s harder to get them out of the hospital, and they have more anxiety and more stress according to Dr. DeHart.
He stated that the infection rates could have been even higher if the authors compared patients with BMIs of 35 or 40 kg/m2 and up to patients of normal weight.
The study authors agree that there is a lack of definitive conclusions from earlier studies and suggest that they were underpowered.
Even with a higher complication rate, total knee replacements allow for an important improvement for patients with a high BMI and it’s still worth doing knee replacements in most of these patients because they have pretty good improvement according to Dr. DeHart.
For those people for whom it works well, they’re very happy.
Patients recovering from knee surgery, obese or not, benefit from the latest physical therapy products such as the LEGTUTOR. The LEGTUTOR consists of a comfortable ergonomically designed leg brace that contains position and speed sensors record precise 3 dimensional knee movements. The LEGTUTOR has a range of motion limiter that limits the dynamic range of extension and flexion of the knee. Special rehabilitation games allow the patient to exercise the limb’s speed and accuracy of movement.
The LEGTUTOR together with its sister devices (HANDTUTOR, ARMTUTOR and 3DTUTOR) are currently in use in leading U.S, and European rehabilitation hospitals and clinics. They are fully certified by the FDA and CE and are available for use by adults and children from the age of 5 and up. The TUTORs can also be used at home through telerehabilitation.
See WWW.MEDITOUCH.CO.IL for further information.
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