Morbid Obesity in Revision Total Knee Arthroplasty: A Significant Risk Factor for Re-Operation

The purpose of this study is to compare surgical and clinical outcomes between matched groups of morbidly obese (body mass index [BMI] >40 kg/m²) and non-morbidly obese (BMI <40 kg/m²) patients undergoing first-time revision total knee arthroplasty with a minimum 5-year follow-up.

Two groups of 87 patients (BMI >40 or <40 kg/m²) were matched 1:1 based on age at the time of revision, gender, and diagnosis for revision (aseptic or septic causes).

The morbidly obese group had a significantly greater incidence of re-operation (34.5% [30/87] vs 16.1% [14/87], P = .005) and re-revision (27.6% [24/87] vs 12.6% [11/87], P = .014) with a significantly lower 10-year survivorship for re-operation (P = .05) and subsequent revision (P = .014). In particular, the aseptic sub-group had a greater incidence of re-operation (29.9% [20/67] vs 13.4% [9/67], P = .021) and re-revision (26.9% [18/67] vs 11.9% [8/67], P = .029). The non-morbidly obese group demonstrated higher final Western Ontario and McMaster Universities Index scores (63.1 ± 19.5 vs 55.5 ± 22.5, P = .030) and a greater change between pre-operative and final KSS (45.6 ± 44.3 vs 39.7 ± 48.4, P = .040) and SF-12 Mental component (3.6 ± 10.8 vs -1.4 ± 10.3, P = .013).

Morbidly obese patients undergoing revision total knee arthroplasty have a greater risk of re-operation and re-revision while experiencing lower clinical outcome scores compared to non-morbidly obese patients. These patients should be informed of the higher potential for re-operation and the possibility of poor results.