Outcomes of unicompartmental knee arthroplasty stratified by body mass index

Patients who have high body mass indices can have disabling medial compartment knee osteoarthritis, which might benefit from unicompartmental knee arthroplasty (UKA). The purpose of this study was to compare clinical and radiographic outcomes of UKAs in patients with body mass indices (BMIs) greater and less than 35 kg/m². Thirty-four patients (40 knees) had BMIs of 35 kg/m² or greater, whereas the remaining 33 patients (40 knees) had BMIs below 35 kg/m², with 2-year minimum follow-up. In the high-BMI group, 5 knees were revised to total knee arthroplasty, compared with none in the lower BMI group. Knee Society scores were lower in the surviving high-BMI knees. All surviving components were radiographically stable. The results suggest that UKA should be approached with caution in patients who have high BMIs.     

Influence of body mass index on revision rates after primary total knee arthroplasty

Purpose

Studies demonstrate that revision rates after primary total knee arthroplasty (TKA) tend to be higher in obese patients. However, the existence of a body mass index (BMI) threshold remains unexplored.

Methods

We conducted a prospective cohort study of 2442 primary TKAs in 2035 patients (69.1 % women; mean age 72 years; mean follow-up 93 months, range 38–203). We evaluated the influence of BMI in five categories on all-cause revision after TKA using incidence rates (IR), hazard ratios (HR), and Kaplan–Meier survival analysis. Adjustment for baseline imbalances was performed using Cox regression analysis.

Results

Over the study period, 71 revisions occurred. Revision rates were 3.2 cases/1000 patient-years for patients of normal weight, 3.4/1000 for overweight patients and 3.0/1000 for patients classified as obese class I. At BMI?≥?35, a significant increase in revision was noted. Comparing BMI?≥?35 vs. < 35, there were 6.4 vs. 3.2 /1000. Crude HR was 2.0 [95 % confidence interval (CI) 1.2–3.3, p?=?0.009], and the adjusted HR was 2.1 (95 % CI 1.2–3.6, p?=?0.008).

Conclusion

All-cause revision rates after primary TKA doubled in patients with a BMI of 35 but were similar in those with a BMI <35.

     

The association of body mass index with same-day hospital admission,postoperative complications,and 30-day readmission following day-case eligible joint arthroscopy: A national registry analysis

Study objectiveWe examined the association of body mass index (BMI) with hospital admission, same-day complications, and 30-day hospital readmission following day-case eligible joint arthroscopy.DesignRetrospective cohort study.SettingMulti-institutional.PatientsAdult patients undergoing arthroscopy of the knee, hip or shoulder in the outpatient setting.InterventionNone.MeasurementsUsing the American College of Surgeons National Surgical Quality Improvement Program dataset from 2012 to 2016, we examined seven BMI ranges: normal BMI (≥20 kg/m² and <25 kg/m²), underweight (<20 kg/m²), overweight (≥25 kg/m² and <30 kg/m²), Class 1 and 2 obese (≥30 kg/m² and <40 kg/m², reference variable), and severe obesity, which we divided into the following BMI ranges: ≥40 kg/m² and <50 kg/m², ≥50 kg/m² and <60 kg/m², and ≥60 kg/m². The primary outcome was hospital admission. Secondary outcomes included same-day postoperative complications and 30-day hospital readmission. We performed multivariable logistic regression and reported odds ratios (OR) and their associated 95% confidence interval (CI) and considered a p-value of <0.05 as statistically significant.Main resultsThere were a total of 99,410 patients included in the final analysis, in which there was a 2.6% rate of hospital admission. When compared to class 3 obesity, only those with BMI ≥50 kg/m² (OR 1.55, 95% CI 1.18–2.01, p = 0.005) had increased odds of hospital admission. There were no differences in 30-day hospital readmission or same-day postoperative complications.ConclusionWe found that only patients with BMI ≥50 kg/m² had increased odds for same-day hospital admission even when patient's comorbid conditions are optimized, suggesting that a BMI ≥50 kg/m² may be used as a sole factor for patient selection in patients undergoing joint arthroscopy. For patients with BMI <50 kg/m², we recommend that BMI alone should not be solely used to exclude patients from having joint arthroscopies performed in an outpatient setting, especially since this patient group makes up a significant proportion of joint arthroscopy.     

中年妇女年龄、月经状态、体重指数及体力活动对机体组成及脂肪分布的影响

目的 研究中年妇女年龄、月经状态、体重指数(body mass index,BMI)及体力活动对机体组成及脂肪分布的影响. 方法 横断面收集于北京协和医院体检中心体检的健康妇女,利用经过效度和信度检验的国际体力活动问卷短卷中文版调查研究对象的体力活动情况,利用双能X线吸收法(DEXA)测定机体组成及脂肪分布情况. 结果 共收集到162例妇女资料,年龄40～62岁、(52.81±5.31)岁.多元线性回归分析结果显示,全身脂肪组织百分比与BMI(标准化偏回归系数b=0.70)、月经状态(b=0.19,生育期赋值1,绝经过渡期赋值2,绝经后赋值3,下同)呈正相关,而与体力活动能量消耗呈负相关(b=-0.17),回归方程的决定系数R2-0.55.全身无脂肪组织含量(fat-free tissue)与BMI呈正相关(b=0.61)、与月经状态呈负相关(b=-0.14),回归方程的决定系数R2=0.39.躯干脂肪/全身脂肪比值与BMI(b=0.32)、月经状态(b=0.30)呈正相关,回归方程的决定系数R2=0.20.校正了BMI、月经状态及体力活动的影响后,年龄与全身脂肪组织百分比、全身无脂肪组织含量、躯干脂肪/全身脂肪比值均无明显相关性. 结论 月经状态对机体组成及脂肪分布具有独立影响,随着生殖衰老的进展,脂肪组织增加且趋于中心性分布,机体无脂肪组织含量降低.而年龄本身与机体组成及脂肪分布无直接关系.中年妇女应增加体力活动,保持适当的体重以降低绝经对脂肪组织所造成的不利变化.     

Effect of body mass index on range of motion and manipulation after total knee arthroplasty

This study evaluates the effects of increased body mass index (BMI) on postoperative range of motion (ROM) and rate of manipulation under anesthesia (MUA) after total knee arthroplasty (TKA) in 391 primary TKAs. Range of motion and incidence of MUA were retrospectively collected and compared between 4 BMI groups (I, BMI <25; II, BMI 25-29.9; III, BMI 30-34.9; IV, BMI >35) using χ² or Fisher exact tests. Patients with higher BMIs had a greater incidence of MUA (I, 9.7%; II, 19%; III, 20%; IV, 15%) and lower preoperative and postoperative ROM. Women had lower ROM and a higher rate of MUA. Age was not a significant predictor of ROM or rate of MUA. Patients at greater risk of complications after TKA should be counseled about realistic surgical outcomes.     

The influence of body mass index on life quality and clinical improvement after total hip arthroplasty

BackgroundThe effect of body mass index (BMI) on the outcome of total hip arthroplasty (THA) remains controversial. The purpose of this study was to examine whether revision rate and postoperative outcomes following THA were influenced by BMI.Materials and methodsWe retrospectively evaluated 714 patients (751 hips) who underwent primary THA in our department between March 1991 and April 2006. They were followed prospectively for 5–20 years with 24 deaths (24 hips) and 33 losses (34 hips). Patients were separated into three groups based on BMI: underweight, normal and obese groups. A survival analysis was performed using revision as the endpoint, and a case-matched study that was matched for age, gender, and laterality was designed; outcomes were assessed with the Harris Hip score, 36-item short-form health survey, complication rate and radiological examination.ResultsThe preoperative scores were lower for the obese group, and the postoperative scores were higher for the normal group. Patients in the obese group obtained the greatest overall improvement in clinical scores from admission to the last follow-up. We found a significantly higher complication rate in the obese group and underweight group. It appears that being underweight was associated with an increased dislocation rate, and obese patients were more likely to have osteolysis, deep vein embolism, and pulmonary thrombosis. The log rank test for survival showed no significant differences among the three groups.ConclusionsAbnormal BMI does not prevent functional rehabilitation after THA; however, patients with abnormal BMI have to face higher complication rates and poorer clinical outcomes following this operation.     

The impact of age, body mass index and testosterone on erectile dysfunction

PURPOSE: Erectile dysfunction (ED) may be associated with low serum total testosterone (T), low serum bioavailable testosterone (BAT) and high body mass index (BMI) in aging men. MATERIALS AND METHODS: A total of 675 workers (age range 45 to 60 years old) were entered into this study. Investigations were performed directly at their place of work. Exclusion criteria were abnormal urogenital status, antihypertensive drugs, medication possibly affecting the endocrine function and a history of previous pelvic trauma. T and sex hormone-binding globulin were measured with commercially available assays, and BAT was calculated from T and sex hormone-binding globulin. BMI was assessed and every individual completed a self-administrated questionnaire for erectile function (International Index of Erectile Function [IIEF-5]). RESULTS: T and BAT showed a significantly negative correlation with age and BMI. Each additional year of increase in age caused a decrease in the IIEF-5 score of 0.195 (p <0.001). Increase in BMI by 1 kg/m reduced IIEF-5 by 0.141, independent of age (p =0.005). Multiple logistic regression analyses confirmed the influence of increased age and higher BMI on the risk of ED. The corresponding odds ratio for ED was 1.082 (p <0.001) and 1.076 (p <0.001), respectively. These data indicate an increase in ED risk by 8.2% per year and by 7.6% per kg/m BMI. Severe cases of ED (IIEF-5 score 7 or less) were significantly associated with a decrease in T and BAT. Individuals with low BAT (1 ng/ml or less) had a 3 times higher risk of severe ED compared with men with BAT greater than 1 ng/ml (odds ratio 3.045, 95% CI 1.088 to 8.522, p =0.034). The result of the multiple logistic regression analysis was adjusted to age and BMI, and did not show a significant influence on the incidence of severe ED. CONCLUSIONS: BMI contributes strongly to ED. Low T or BAT are only relevant if IIEF-5 questionnaire results in severe ED.     

Recipient body mass index and age interact to impact survival after heart transplantation

Although recipient body mass index (BMI) and age are known risk factors for mortality after heart transplantation, how they interact to influence survival is unknown. Our study utilized the UNOS registry from 1997 to 2012 to define the interaction between BMI and age and its impact on survival after heart transplantation. Recipients were stratified by BMI: underweight (<18.5), normal weight (18.5–24.99), overweight (25–29.99), and either moderate (30–34.99), severe (35–39.99), or very severe (≥40) obesity. Recipients were secondarily stratified based on age: 18–40 (younger recipients), 40–65 (reference group), and ≥65 (advanced age recipients). Among younger recipients, being underweight was associated with improved adjusted survival (HR 0.902; p = 0.010) while higher mortality was seen in younger overweight recipients (HR 1.260; p = 0.005). However, no differences in adjusted survival were appreciated in underweight and overweight advanced age recipients. Obesity (BMI ≥ 30) was associated with increased adjusted mortality in normal age recipients (HR 1.152; p = 0.021) and even more so with young (HR 1.576; p < 0.001) and advanced age recipients (HR 1.292; p = 0.001). These results demonstrate that BMI and age interact to impact survival as age modifies BMI–mortality curves, particularly with younger and advanced age recipients.     

Effect of body mass index on functional outcomes following arthroplasty procedures

AIM: To evaluate the body mass index (BMI) change in arthroplasty patients and its impact on the patients’ functional results.METHODS: Between October 2010 and May 2013, 606 patients who were operated due to gonarthrosis, coxarthrosis, aseptic loosening of the total knee and hip prosthesis were evaluated prospectively. Patients were operated by three surgeons in three medical centers. Patients who were between 30-90 years of age and who were underwent total knee arthroplasty, total hip arthroplasty, revision knee arthroplasty, or revision hip arthroplasty were included in the study. We excluded the patients who cannot tolerate our standard postoperative rehabilitation program. Additionally, patients who had systemic inflammatory diseases, diabetes mellitus, or endochrinopathies were excluded from the study. The remaining 513 patients comprised our study group. Preoperative functional joint scores, height, weight and BMI of all patients were recorded. We used the Knee Society Score (KSS) for knee and Harris Hip Score (HHS) for hip patients. Postoperative functional scores were measured at 1^st, 6^th and 12^th months and recorded separately at outpatient visits.RESULTS: The mean age of the patients was 64.7 (range: 30-90) years (207 males/306 females) and the mean follow-up duration was 14.3 (range: 12-26) mo. We found that arthroplasty patients had weight gain and had an increase in BMI at the postoperative 1^st, 6^th and 12^th months. The mean BMI of the patients was 27.7 preoperatively, 27.8 at the postoperative 1^st month, 28.1 at the 6^th month and 28.6 at the 12^th month (P < 0.01). At the last visit, the mean postoperative HHS of the hip arthroplasty patients was 82.2 ± 7.12 (preoperatively, 52.3; 1^st month, 78.2; 6^th month, 81.1; 12^th month, 82.2), and the mean KSS of the knee arthroplasty patients was 79.3 ± 4.31 (preoperatively, 35.8; 1^st month, 75.2; 6^th month, 79.1; 12^th month, 79.3). Worse functional results were noted in the patients who had a BMI increase, however, this correlation was statistically significant only at the postoperative 6^th month (P = 0.03).CONCLUSION: To prevent the negative functional effects of this weight gain during the postoperative period, arthroplasty patients should be advised for weight control and risky patients should consult with a dietician.     

Role of preoperative pain,muscle function,and activity level in discharge readiness after fast-track hip and knee arthroplasty

Methods Before surgery, hip pain (THA) or knee pain (TKA), lower-extremity muscle power, functional performance, and physical activity were assessed in a sample of 150 patients and used as independent variables to predict the outcome (dependent variable)—readiness for hospital discharge —for each type of surgery. Discharge readiness was assessed twice daily by blinded assessors.Results Median discharge readiness and actual length of stay until discharge were both 2 days. Univariate linear regression followed by multiple linear regression revealed that age was the only independent predictor of discharge readiness in THA and TKA, but the standardized coefficients were small (≤ 0.03).Interpretation These results support the idea that fast-track THA and TKA with a length of stay of about 2–4 days can be achieved for most patients independently of preoperative functional characteristics.Over the last decade, length of stay (LOS) with discharge to home after primary THA and TKA has declined from about 5–10 days to about 2–4 days in selected series and larger nationwide series (Malviya et al. 2011, Raphael et al. 2011, Husted et al. 2012, Kehlet 2013, Hartog et al. 2013, Jørgensen and Kehlet 2013). However, there is a continuing debate about whether selected patients only or all patients should be scheduled for “fast-track” THA and TKA in relation to psychosocial factors and preoperative pain and functional status (Schneider et al. 2009, Hollowell et al. 2010, Macdonald et al. 2010, Antrobus and Bryson 2011, Jørgensen and Kehlet 2013), or whether organizational or pathophysiological factors in relation to the surgical trauma may determine the length of stay (Husted et al. 2011, Husted 2012).We studied the role of THA and TKA patients’ preoperative pain and functional characteristics in discharge from 2 orthopedic departments with well-established fast-track recovery regimens (Husted et al. 2010).     

体重指数对骨关节炎患者术后疗效的影响

目的 ：探讨不同体重指数（body mass index,BMI）对接受全膝关节置换术（total knee arthroplasty,TKA）的骨关节炎患者膝关节疗效的影响。方法：对2006年6月至2009年5月施行TKA并且有完整随访资料的148例骨关节炎患者进行回顾性分析,男29例,女119例;年龄39~89岁,平均71.2岁。按体重指数分类标准分为4组：非肥胖组（BMI≤25.0 kg/m2）38例45膝,男9例,女29例,平均年龄（70.0±8.2）岁;超重组（BMI 25.1~27.0 kg/m2）40例48膝,男10例,女30例,平均年龄（72.6±7.4）岁;肥胖组（BMI 27.1~30.0 kg/m2）37例43膝,男7例,女30例,平均年龄（70.4±6.0）岁;病理性肥胖组（BMI〉30.0 kg/m2）33例39膝,男3例,女30例,平均年龄（71.7±6.4）岁。分别记录各组术前和随访时KSS评分,膝前痛及手术时髌骨软骨损坏情况。结果：各组患者术后KSS评分与术前相比均有大幅提高,优良率97.1%。在膝评分方面,术前及术后各组之间差异均无统计学意义（术前P=0.789,术后P=0.133）;在膝功能评分中,肥胖组的术前功能评分最低,与其他组相比差异有统计学意义（术前P=0.036,术后P=0.225）。术后膝前痛发生率为9.7%（17/175）,其中14膝为Ⅰ级,3膝为Ⅱ级。各组术后膝前痛发生率差异无统计学意义（χ2=0.764,P=0.862）。发生膝前痛的患者平均体重指数（27.4±3.6）kg/m2,无膝前痛的患者平均体重指数（27.5±4.4）kg/m2,差异无统计学意义（t=-0.061,P=0.951）。各组髌骨软骨损坏程度差异无统计学意义（χ2=7.070,P=0.314）。结论 ：不同BMI患者膝关节评分和功能评分都有大幅提高,都能从TKA手术中获益,并且肥胖患者术后疗效可以与非肥胖患者一样好。     

Risk of 30-day readmission in patients aged 75 years and older following same-day discharge for primary total shoulder arthroplasty

BackgroundLittle is known about the safety and feasibility of same-day discharge following primary total shoulder arthroplasty (anatomic and reverse, SA) in geriatric patients, who may have more comorbidities and be at higher risk of surgical complications. The purpose of this study is to evaluate whether patients aged 75 years or older undergoing same-day discharge following primary SA are at an increased risk for certain complications, readmission, or mortality compared to their younger counterparts.MethodsThe 2007-2019 National Surgical Quality Improvement Program database was used to identify all primary SA patients who underwent same-day discharge. Patients were categorized into 2 cohorts, younger than 75 years and aged 75 years or older. Bivariate and multivariate analyses were performed to compare the 2 cohorts.ResultsOf 1637 SA patients who were discharged on the same day, 1246 (76.1%) patients were younger than 75 years, and 391 (23.9%) were aged 75 years or older. Bivariate analyses showed that patients aged 75 years or older were more likely to develop urinary tract infections (P = .003) and require hospital readmission (P = .002). After controlling for potential confounding variables on multivariate analysis, the cohort of patients aged 75 years or older had an increased risk of unplanned hospital readmission compared to patients younger than 75 years (odds ratio 3.99; P = .001).ConclusionPatients of age 75 years or older are at an increased risk for unplanned hospital readmission within 30 days of same-day discharge following primary SA. Surgeons and patients should be aware of this risk when evaluating SA candidates for same-day discharge.     

Influence of age and body mass index on the yield and proliferation capacity of adipose-derived stem cells

Background  

Adipose tissue is commonly used for volume restoration. It is also a source of adipose-derived stem cells (ASCs), easy to obtain in large quantities by liposuction or resection techniques. The aim of this study was to determine the influence of body mass index (BMI) and age on the number (yield) and proliferation capacity of ASCs.     

体质量指数对机器人辅助腹腔镜全子宫切除术的影响

目的:探讨体质量指数(Body mass index,BMI)对机器人辅助腹腔镜全子宫切除术的影响。方法:收集中国医科大学附属第一医院妇科行机器人辅助腹腔镜全子宫切除术的131例患者的临床资料,根据体质量指数的不同,将患者分为正常体重组(BMI<24kg/m²)、超重组(BMI为24~28kg/m²)和肥胖组(BMI≥28kg/m²),比较三组患者年龄、术前有内科合并症(高血压、冠心病或糖尿病)患者的占比、手术时间、中转开腹率,以及术后血红蛋白下降程度、排气时间、术后住院日等。结果:超重组和肥胖组术前有内科合并症(高血压、冠心病或糖尿病)患者的比例超过正常体重组。而在年龄、手术时间、术后血红蛋白下降程度、排气时间、术后住院日方面,体重正常组与超重组及肥胖组比较,差异无统计学意义(P>0.05),所有患者无1例中转开腹。结论:机器人辅助腹腔镜全子宫切除术对于超重及肥胖的患者是安全、可行的,在患者基础条件不佳的情况下,可以获得与正常体重患者相似的术中及术后结局,是一种可以选择的手术方式。