No Increased Complications Seen Among Obese Patients After Unicompartmental Knee Arthroplasty at 5-Year Follow-Up

Body mass index (BMI) cutoffs remain controversial in unicompartmental knee arthroplasty (UKA), as one must balance complication risks and the need for conversion to total knee arthroplasty (TKA). This study aimed to analyze the impact of BMI, stratified by obesity class, on: (1) 90-day and 1- and 2-year postoperative complications; and (2) the 2- and 5-year TKA conversion rates.

We used a national, all-payer database to identify 4,823 patients who underwent UKA from 2016 to 2022 who had a history of osteoarthritis. Patients who had malignancy or trauma were excluded. Patients were stratified by BMI into four cohorts: BMI 20 to 29.9 (n = 923), BMI 30 to 34.9 (n = 1,404), BMI 35 to 39.9 (n = 1,052), and BMI 40+ (n = 698). We analyzed: (1) demographics and comorbidities, (2) complication rates at 90 days, and 1 and 2 years; and (3) rates of conversion to TKA at 5 years in patients who have a 5-year follow-up.

Higher BMI was associated with younger age and increased incidence of diabetes. No differences were seen in complication rates at 90 days, and 1 and 2 years between BMI groups. Unadjusted odds ratios (ORs) demonstrated increased 2-year TKA conversion risk among BMI groups 35 to 39.9 (OR 1.34, 95% confidence interval [CI] 1.02 to 1.78) and 40+ (OR 1.61, 95% CI 1.20 to 2.18). However, these were not significant following multivariate regressions. The highest odds were in the BMI 40+ group (OR 1.52, 95% CI 1.00 to 2.33), though still not statistically significant. Subgroup analysis of patients who had a 5-year follow-up showed no differences in TKA conversion rates.

Obese patients across BMI subclasses demonstrated no increased risk of postoperative complications after UKA. At 5 years, obese patients demonstrated no significant risk of conversion to TKA.