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The Impact of Preoperative Weight Loss on 90-Day Complications Following Primary Total Knee Arthroplasty
John Paul Lewis1, Mary Ziemba-Davis2, Leonard T Buller3
1Department of Graduate Medical Education, Indiana University School of Medicine, Indianapolis, IN, USA.
Background:
Access to primary total knee arthroplasty (TKA) for morbidly obese (MO) patients is often restricted to reduce complications. We compared complication rates in patients who were MO or non-MO (NMO) at initial presentation based on whether their body mass index (BMI) had decreased by ≥5%, remained stable, or increased by ≥5% at the time of surgery, hypothesizing that preoperative weight loss does not reduce complication rates.
Methods:
Prospectively collected data for 2219 unilateral, primary TKAs were retrospectively reviewed. Cases were performed between 2012 and 2023 at the same academic center by 4 fellowship-trained surgeons using standardized protocols. Twenty-eight percent (n = 627) were MO and 72% (n = 1592) were NMO at initial presentation. Outcomes included intraoperative and 90-day complications and reoperations. Outcome covariates included patient demographics and comorbidities, as well as operative details. Independent samples t-tests and chi-squared tests were used for statistical analysis.
Results:
Intraoperative complications (P = .999), medical complications (P ≥ .398), death (P = .299), superficial or deep infection (P = .731), and reoperation on the index joint within 90 days of surgery (P = .801) did not differ in MO patients with a ≥5% decrease vs stable BMI before surgery. These outcomes also did not differ between NMO patients with a ≥5% decrease in BMI and those with stable BMI before surgery (P ≥ .250).
Conclusions:
Findings suggest that withholding surgery from patients who are clinically indicated for TKA pending weight loss may not be necessary to reduce early postoperative complications.
Insights
Preoperative weight loss does not significantly reduce complications for morbidly obese patients undergoing total knee arthroplasty (TKA). These findings suggest surgery should not be withheld based on BMI changes before TKA.
Area of Science:
- Orthopedic Surgery
- Obesity Medicine
- Patient Outcomes Research
Background:
- Morbidly obese (MO) patients often face restricted access to primary total knee arthroplasty (TKA) due to concerns about complications.
- This study investigates whether preoperative weight loss impacts complication rates in MO and non-MO (NMO) patients undergoing TKA.
Purpose of the Study:
- To compare complication rates in MO and NMO patients based on body mass index (BMI) changes before TKA.
- To determine if preoperative weight loss is necessary to mitigate complications in MO patients undergoing TKA.
Main Methods:
- Retrospective review of 2219 primary TKA cases performed between 2012 and 2023.
- Analysis of intraoperative and 90-day complications, including infections and reoperations.
- Comparison of complication rates between MO and NMO patients with varying BMI changes (≥5% decrease, stable, ≥5% increase).
Main Results:
- No significant difference in intraoperative complications, medical complications, death, infection, or reoperation rates was observed between MO patients who lost ≥5% BMI and those with stable BMI.
- Similar findings were noted for NMO patients comparing those with ≥5% BMI decrease versus stable BMI.
- Complication rates did not differ based on BMI changes in either MO or NMO groups.
Conclusions:
- Withholding TKA from clinically indicated patients solely based on BMI may not be necessary to reduce early postoperative complications.
- Preoperative weight loss does not appear to significantly alter complication profiles in the early postoperative period for TKA patients.
- Current findings support proceeding with TKA for MO patients when indicated, irrespective of minor preoperative BMI fluctuations.
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