Jeries Hakim1, Gershon Volpin2,3, Mahmud Amashah1, Faris Alkeesh1, Saker Khamaisy1, Miri Cohen1,4, Jamal Ownallah1. 1. Department of Orthopedic Surgery, EMMS Hospital, Nazareth, Affiliated to Galilee Medical Faculty Zfat, Bar Ilan University, Ramat Gan, Israel. 2. Department of Orthopedic Surgery, EMMS Hospital, Nazareth, Affiliated to Galilee Medical Faculty Zfat, Bar Ilan University, Ramat Gan, Israel. volpinger@gmail.com. 3. Faculty of Social Welfare and Health Sciences and the Center for Rehabilitation Research, University of Haifa, Haifa, Israel. volpinger@gmail.com. 4. Faculty of Social Welfare and Health Sciences and the Center for Rehabilitation Research, University of Haifa, Haifa, Israel.
Abstract
INTRODUCTION: Patients with morbid obesity and advanced painful knee osteoarthritis are considered as poor candidates for total knee replacement. Our aims were to evaluate the outcomes of TKR surgery and the risks for post-operative complications in patients with morbid obesity (BMI > 40 kg/m2) as compared with obese patients (30 < BMI ≤ 40 kg/m2) and non-obese patients, BMI < 30 kg/m2); to evaluate if there are differences between morbid-obese patients (BMI 40-49.99 kg/m2) and extreme morbid obese patients (BMI > 50 kg/m2); and to present some surgical tips which can improve the TKR outcomes in morbid obese patients. MATERIALS AND METHODS: There were successive 333 patients, of them 39 patients (11.7%) were lost for follow-up. So, this series included 292 patients - 82 with bilateral TKR- and 374 TKR. The mean age was 64.3 years old (48-83 years) and the mean follow-up 10.8 years (4-17 years). The KSS and FKSS scores were calculated at the end of the follow-up period and compared to the pre-operative evaluation. Radiographic assessment at the end of follow-up included evaluation of implant position, alignment, and presence of radiolucent lines around the implants and was compared with the immediate post-operative radiographs. Statistical analysis was performed using SPSS v 22.0. RESULTS: Our findings showed marked improvement following TKR of non-obese, obese, and morbid obese patients, regarding the KSS and FKSS. Significant change was observed between the non-obese and obese patients as compared to morbid obese patients. There were no significant differences between morbid obese patients with BMI > 40 versus those with BMI > 50. There was a slight increased risk of early complications following TKR in morbid obese patients such as skin necrosis and infection around the surgical incision. CONCLUSIONS: Marked improvement was observed in the three groups of patients after TKR, although non-obese and obese groups had better mean scores of KSS and FKSS than morbid obese patients. No significant differences were found within the morbid obese patients themselves. Therefore, we believe that morbid obese patients are appropriate candidates and can enjoy the benefits of total knee arthroplasty done with careful use of some surgical tips presented in our study.
INTRODUCTION:Patients with morbid obesity and advanced painful knee osteoarthritis are considered as poor candidates for total knee replacement. Our aims were to evaluate the outcomes of TKR surgery and the risks for post-operative complications in patients with morbid obesity (BMI > 40 kg/m2) as compared with obesepatients (30 < BMI ≤ 40 kg/m2) and non-obesepatients, BMI < 30 kg/m2); to evaluate if there are differences between morbid-obesepatients (BMI 40-49.99 kg/m2) and extreme morbid obesepatients (BMI > 50 kg/m2); and to present some surgical tips which can improve the TKR outcomes in morbid obesepatients. MATERIALS AND METHODS: There were successive 333 patients, of them 39 patients (11.7%) were lost for follow-up. So, this series included 292 patients - 82 with bilateral TKR- and 374 TKR. The mean age was 64.3 years old (48-83 years) and the mean follow-up 10.8 years (4-17 years). The KSS and FKSS scores were calculated at the end of the follow-up period and compared to the pre-operative evaluation. Radiographic assessment at the end of follow-up included evaluation of implant position, alignment, and presence of radiolucent lines around the implants and was compared with the immediate post-operative radiographs. Statistical analysis was performed using SPSS v 22.0. RESULTS: Our findings showed marked improvement following TKR of non-obese, obese, and morbid obesepatients, regarding the KSS and FKSS. Significant change was observed between the non-obese and obesepatients as compared to morbid obesepatients. There were no significant differences between morbid obesepatients with BMI > 40 versus those with BMI > 50. There was a slight increased risk of early complications following TKR in morbid obesepatients such as skin necrosis and infection around the surgical incision. CONCLUSIONS: Marked improvement was observed in the three groups of patients after TKR, although non-obese and obese groups had better mean scores of KSS and FKSS than morbid obesepatients. No significant differences were found within the morbid obesepatients themselves. Therefore, we believe that morbid obesepatients are appropriate candidates and can enjoy the benefits of total knee arthroplasty done with careful use of some surgical tips presented in our study.
Entities:
Keywords:
Knee; Morbid obesity; Obesity; Osteoarthritis; Total knee arthroplasty; Total knee replacement
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