The purpose of this study was to determine the association between prior sleeve gastrectomy in patients undergoing primary total hip and knee arthroplasty, and 90-day complications, incidence of revision arthroplasty, and patient-reported outcome scores at final follow-up. This is a retrospective, single-centre analysis. Patients undergoing primary hip or knee arthroplasty with a prior sleeve gastrectomy were eligible for inclusion (n = 80 patients). A morbidly obese control group was established from the same institutional registry using a 1:2 match, for cases:controls with arthroplasty based on propensity score using age, sex, pre-sleeve gastrectomy BMI, Current Procedural Terminology code to identify anatomical location, and presurgical haemoglobin A1C. Outcomes included 90-day complications, incidence of revision arthroplasty, and patient-reported outcome scores at final follow-up. Multivariable logistic regressions evaluated associations of underlying preoperative demographic and treatment characteristics with outcomes.Aims
Methods
The August 2024 Knee Roundup. 360. looks at: Calcification’s role in knee osteoarthritis: implications for surgical decision-making; Lower complication rates and shorter lengths of hospital stay with technology-assisted total knee arthroplasty; Revision surgery: the hidden burden on surgeons; Are preoperative weight loss interventions worthwhile?; Total knee arthroplasty with or without prior
The April 2023 Knee Roundup. 360. looks at: Does
We studied the outcomes of hip and knee arthroplasties in a high-volume arthroplasty centre to determine if patients with morbid obesity (BMI ≥ 40 kg/m2) had unacceptably worse outcomes as compared to those with BMI < 40 kg/m2. In a two-year period, 4,711 patients had either total hip arthroplasty (THA; n = 2,370), total knee arthroplasty (TKA; n = 2,109), or unicompartmental knee arthroplasty (UKA; n = 232). Of these patients, 392 (8.3%) had morbid obesity. We compared duration of operation, anaesthetic time, length of stay (LOS), LOS > three days, out of hours attendance, emergency department attendance, readmission to hospital, return to theatre, and venous thromboembolism up to 90 days. Readmission for wound infection was recorded to one year. Oxford scores were recorded preoperatively and at one year postoperatively.Aims
Methods
The purpose of this study was to assess total knee arthroplasty (TKA) volume and rates of early complications in morbidly obese patients over the last decade, where the introduction of quality models influencing perioperative care pathways occurred. Patients undergoing TKA between 2011 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI < 40 kg/m2 and ≥ 40 kg/m2 and evaluated by the number of cases per year. The 30-day rates of any complication, wound complications, readmissions, and reoperation were assessed. Trends in these endpoints over the study period were compared between groups using odds ratios (ORs) and multivariate analyses.Aims
Methods
The impact of tobacco use on readmission and medical and surgical complications has been documented in hip and knee arthroplasty. However, there remains little information about the effect of smoking on the outcome after total shoulder arthroplasty (TSA). We hypothesized that active smokers are at an increased risk of poor medical and surgial outcomes after TSA. Data for patients who underwent arthroplasty of the shoulder in the USA between January 2011 and December 2015 were obtained from the National Readmission Database, and 90-day readmissions and complications were documented using validated coding methods. Multivariate regression analysis was performed to quantify the risk of smoking on the outcome after TSA, while controlling for patient demographics, comorbidities, and hospital-level confounding factors.Aims
Methods
Aims. The aim of this study was to observe the implications of withholding total joint arthroplasty (TJA) in morbidly obese patients. Patients and Methods. A total of 289 morbidly obese patients with end-stage osteoarthritis were prospectively followed. There were 218 women and 71 men, with a mean age of 56.3 years (26.7 to 79.1). At initial visit, patients were given information about the risks of TJA in the morbidly obese and were given referral information to a bariatric clinic. Patients were contacted at six, 12, 18, and 24 months from initial visit. Results. The median body mass index (BMI) at initial visit was 46.9 kg/m. 2. (interquartile range (IQR) 44.6 to 51.3). A total of 82 patients (28.4%) refused to follow-up or answer phone surveys, and 149 of the remaining 207 (72.0%) did not have surgery. Initial median BMI of those 149 was 47.5 kg/m. 2. (IQR 44.6 to 52.5) and at last follow-up was 46.7 kg/m. 2. (IQR 43.4 to 51.2). Only 67 patients (23.2%) went to the bariatric clinic, of whom 14 (20.9%) had
Introduction. Morbid obesity (BMI>40) is a significant risk factor for complications following total joint arthroplasty (TJA). As such many have a restrictive practice of withholding elective primary TJA in the morbidly obese. The purpose of this study was to observe the implications of this practice. Methods. From 2012 to 2014, 289 patients with morbid obesity and end-stage OA of the hip or knee were prospectively followed. At initial visit, patients were given a packet on risks of TJA in the morbidly obese and referral information to a weight loss clinic. Patients were contacted at 6, 12, 18 and 24 months from initial visit for PROs, and BMI changes. The average age of patients was 56 (26.7–79.1) there were 218 females and 71 males. Results. The average BMI at initial visit was 46.9 (39.9–68.2). 85 patients (29%) refused additional follow up or to answer phone surveys regarding their status. 146 patients (50.5%) have not had surgery. Initial BMI in this cohort was 47.4 (39.9–68.6) and at last follow up was 46.8 (28.9–70.8). Of those, 11 (7.5%) had a last follow up BMI≤40. Only 23% of patients went to the bariatric clinic and 13% had
The aim of this study was to examine the association between
postoperative glycaemic variability and adverse outcomes following
orthopaedic surgery. This retrospective study analyzed data on 12 978 patients (1361
with two operations) who underwent orthopaedic surgery at a single
institution between 2001 and 2017. Patients with a minimum of either
two postoperative measurements of blood glucose levels per day,
or more than three measurements overall, were included in the study.
Glycaemic variability was assessed using a coefficient of variation
(CV). The length of stay (LOS), in-hospital complications, and 90-day
readmission and mortality rates were examined. Data were analyzed
with linear and generalized linear mixed models for linear and binary
outcomes, adjusting for various covariates.Aims
Patients and Methods
Obesity is a leading public health concern and it is increasing in prevalence over the last 20 years. Obesity prevalence has doubled in adults and tripled in adolescents. The United States is the leading country in terms of percent obesity. Most alarming is the fact that the fastest growing rates of obesity are in the highest BMI groups. The issue of obesity is a particular concern to arthroplasty surgeons since there is an association between the increasing incidence of obesity and the increasing rate of joint replacement. Also of concern is that obese patients tend to be younger and complication rates and revision rates are higher in young patients which is only compounded by the presence of obesity. The risk of virtually every major complication is substantially higher in obese patients. Of concern, however, is a recent study indicating that
C.D. Watts, J.R. Martin, M. T. Houdek, M. P. Abdel, D. G.Lewallen, M. J. Taunton Prior
The following papers will be discussed during this session: 1) Staph Screening and Treatment Prior to Elective TJA; 2) Unfulfilled Expectations Following TJA Procedures; 3) Thigh Pain in Short Stem Cementless Components in THR; 4) Is the Direct Anterior Approach a Risk Factor for Early Failure?; 5) THA Infection - Results of a 2nd 2-Stage Re-implantation - Clinical Trial of Articulating and Static Spacers; 6) THA Revision - Modular vs. Non Modular Fluted Tapered Stems-Total Femoral Replacement for Femoral Bone Loss - Cage + TM Augment vs. Cup Cage for Acetabular Bone Loss; 7) Do Injections Increase the Risk of Infection Prior to TKA?; 8) Long-Acting Opioid Use Predicts Perioperative Complication in TJA; 9) UKA vs. HTO in Patients Under 55 at 5–7 years; 10) Stemming Tibial Component in TKA Patients with a BMI > 30; 11) The Effect of
In the USA, 34.9% of adults are currently obese (BMI > 30). Growth in total knee arthroplasty (TKA) is outpacing growth in total hip arthroplasty (THA) largely due to a differential utilization of TKA in overweight patients in the USA. In a recent study, 54.5% of patients reporting to arthroplasty clinics in the USA were obese. From 2006–2010, 61.2% of primary unilateral TKA patients in the USA ACS-NSQIP database were obese. Arthroplasty surgeons are directly affected by the obesity epidemic and need to understand how to safely offer a range of peri-operative care for these patients in order to insure good clinical outcomes. Pre-operative care for the obese patient involves nutritional counseling, weight loss methods, consideration for
Aims. Our aim was to determine whether, based on the current literature,
bariatric surgery prior to total hip (THA) or total knee arthroplasty
(TKA) reduces the complication rates and improves the outcome following
arthroplasty in obese patients. Methods. A systematic literature search was undertaken of published and
unpublished databases on the 5 November 2015. All papers reporting
studies comparing obese patients who had undergone bariatric surgery
prior to arthroplasty, or not, were included. Each study was assessed
using the Downs and Black appraisal tool. A meta-analysis of risk ratios
(RR) and 95% confidence intervals (CI) was performed to determine
the incidence of complications including wound infection, deep vein
thrombosis (DVT), pulmonary embolism (PE), revision surgery and
mortality. Results. From 156 potential studies, five were considered to be eligible
for inclusion in the study. A total of 23 348 patients (657 who
had undergone
Aims. We compared the outcome of total hip arthroplasty (THA) in obese
patients who previously underwent