J Knee Surg 2018; 31(09): 884-888
DOI: 10.1055/s-0037-1615802
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparing the Efficacy of the Total Stabilizing and Posterior Stabilizing Knee Prostheses in Obese and Preobese Females: A Retrospective Cohort Study

Kellen Worhacz
1   Department of Orthopedics, Musculoskeletal Orthopedic Research and Education, Phoenix, Arizona
,
Marc C. Jacofsky
2   Research and Development, The CORE Institute, Phoenix, Arizona
3   SHRI-CORE Orthopedic Research Labs, Banner Sun Health Research Institute, Sun City West, Arizona
,
David J. Jacofsky
4   Adult Reconstruction, The CORE Institute, Phoenix, Arizona
,
Sarim Ahmed
5   Department of Orthopedics, The CORE Institute, Phoenix, Arizona
› Institutsangaben
Funding None.
Weitere Informationen

Publikationsverlauf

03. März 2017

22. November 2017

Publikationsdatum:
22. Januar 2018 (online)

Abstract

Obesity is associated with increased surgical complications that may lead to suboptimal total knee arthroplasty (TKA) outcomes. Additionally, females exhibit increased rates of severe, clinical osteoarthritis OA, along with increased ligamentous laxity. Therefore, obese females present a particularly challenging case for TKA with increased joint loads coupled with a propensity for instability. This study retrospectively analyzed knee range of motion and stability of one TKA designs with two different degrees of polyethylene conformity in the obese female population. The implants (Stryker Triathlon total stabilizing [TS] and Stryker Triathlon posterior stabilizing [PS]) differ in their level of constraint, with the TS being more constrained. We hypothesized that the TS implants would be associated with improved functional outcomes in the obese female population, secondary to increased coronal stability to offset the ligamentous laxity. Of 482 knees reviewed, 173 met the inclusion criteria of: female, body mass index (BMI) ≥ 25, receiving TS (N = 93), or PS (N = 8). Primary knee outcome measures were: active flexion, passive flexion, active extension, passive extension, and stability at 0° and 30° flexion. These factors were statistically analyzed at preop, 2-week, 6-week, 3-month, and 1-year time points. Preoperatively, the TS cohort was significantly higher in BMI and knee laxity, potentially starting this cohort at a functional disadvantage. Postoperatively, the TS implant was associated with a statistically significant early improvement in active and passive knee extension. There was no longer any significant difference in knee laxity postop. Our data support the hypothesis that obese females may benefit from the increased stability afforded by the TS design.

 
  • References

  • 1 World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii , 1–253
  • 2 Workgroup of the American Association of Hip and Knee Surgeons Evidence Based Committee. Obesity and total joint arthroplasty: a literature based review. J Arthroplasty 2013; 28 (05) 714-721
  • 3 Finucane MM, Stevens GA, Cowan MJ. , et al; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index). National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011; 377 (9765): 557-567
  • 4 Finkelstein EA, Khavjou OA, Thompson H. , et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med 2012; 42 (06) 563-570
  • 5 National Center for Health Statistics. Thompson TG, Gerberding JL, Sondik EJ. . Health, United States, 2004: With Chartbook on Trends in the Health of Americans; 2004
  • 6 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311 (08) 806-814
  • 7 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011-2012. NCHS Data Brief 2013; 131: 1-8
  • 8 Campos P, Saguy A, Ernsberger P, Oliver E, Gaesser G. The epidemiology of overweight and obesity: public health crisis or moral panic?. Int J Epidemiol 2006; 35 (01) 55-60
  • 9 Lee R, Kean WF. Obesity and knee osteoarthritis. Inflammopharmacology 2012; 20 (02) 53-58
  • 10 Kerkhof HJM, Bierma-Zeinstra SM, Arden NK. , et al. Prediction model for knee osteoarthritis incidence, including clinical, genetic and biochemical risk factors. Ann Rheum Dis 2014; 73 (12) 2116-2121
  • 11 Yeung E, Thornton-Bott P, Walter WL. Patient obesity: a growing concern of successful total knee arthroplasty. Semin Arthroplasty 2010; 21: 87-91
  • 12 Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol 2014; 28 (01) 5-15
  • 13 Lawrence RC, Felson DT, Helmick CG. , et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58 (01) 26-35
  • 14 Jiang L, Tian W, Wang Y. , et al. Body mass index and susceptibility to knee osteoarthritis: a systematic review and meta-analysis. Joint Bone Spine 2012; 79 (03) 291-297
  • 15 Felson DT, Lawrence RC, Dieppe PA. , et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 2000; 133 (08) 635-646
  • 16 Lee KM, Chung CY, Sung KH. , et al. Risk factors for osteoarthritis and contributing factors to current arthritic pain in South Korean older adults. Yonsei Med J 2015; 56 (01) 124-131
  • 17 Lohmander LS, Gerhardsson de Verdier M, Rollof J, Nilsson PM, Engström G. Incidence of severe knee and hip osteoarthritis in relation to different measures of body mass: a population-based prospective cohort study. Ann Rheum Dis 2009; 68 (04) 490-496
  • 18 Carman WJ, Sowers M, Hawthorne VM, Weissfeld LA. Obesity as a risk factor for osteoarthritis of the hand and wrist: a prospective study. Am J Epidemiol 1994; 139 (02) 119-129
  • 19 Arden NK, Leyland KM. Osteoarthritis year 2013 in review: clinical. Osteoarthritis Cartilage 2013; 21 (10) 1409-1413
  • 20 Yoshimura N, Muraki S, Oka H. , et al. Accumulation of metabolic risk factors such as overweight, hypertension, dyslipidaemia, and impaired glucose tolerance raises the risk of occurrence and progression of knee osteoarthritis: a 3-year follow-up of the ROAD study. Osteoarthritis Cartilage 2012; 20 (11) 1217-1226
  • 21 Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 2009; 24 (6, Suppl): 84-88
  • 22 Núñez M, Lozano L, Núñez E, Sastre S, Luis Del Val J, Suso S. Good quality of life in severely obese total knee replacement patients: a case-control study. Obes Surg 2011; 21 (08) 1203-1208
  • 23 Bozic KJ, Lau E, Ong K. , et al. Risk factors for early revision after primary TKA in Medicare patients. Clin Orthop Relat Res 2014; 472 (01) 232-237
  • 24 Bozic KJ, Lau E, Kurtz S, Ong K, Berry DJ. Patient-related risk factors for postoperative mortality and periprosthetic joint infection in Medicare patients undergoing TKA. Clin Orthop Relat Res 2012; 470 (01) 130-137
  • 25 Jiang J, Teng Y, Fan Z, Khan S, Xia Y. Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res 2014; 472 (03) 968-975
  • 26 White RH, Henderson MC. Risk factors for venous thromboembolism after total hip and knee replacement surgery. Curr Opin Pulm Med 2002; 8 (05) 365-371
  • 27 Kim YH, Kim VE. Factors leading to low incidence of deep vein thrombosis after cementless and cemented total knee arthroplasty. Clin Orthop Relat Res 1991; (273) 119-124
  • 28 Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL. Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty. Anesthesiology 2003; 99 (03) 552-560 , discussion 5A
  • 29 Cho HJ, Chang CB, Kim KW. , et al. Gender and prevalence of knee osteoarthritis types in elderly Koreans. J Arthroplasty 2011; 26 (07) 994-999
  • 30 Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis Cartilage 2005; 13 (09) 769-781
  • 31 Manninen P, Riihimäki H, Heliövaara M, Mäkelä P. Overweight, gender and knee osteoarthritis. Int J Obes Relat Metab Disord 1996; 20 (06) 595-597
  • 32 Oliveria SA, Felson DT, Reed JI, Cirillo PA, Walker AM. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum 1995; 38 (08) 1134-1141
  • 33 Martín-Millán M, Castañeda S. Estrogens, osteoarthritis and inflammation. Joint Bone Spine 2013; 80 (04) 368-373
  • 34 Roman-Blas JA, Castañeda S, Largo R, Herrero-Beaumont G. Osteoarthritis associated with estrogen deficiency. Arthritis Res Ther 2009; 11 (05) 241
  • 35 Castañeda S, Largo R, Calvo E, Bellido M, Gómez-Vaquero C, Herrero-Beaumont G. Effects of estrogen deficiency and low bone mineral density on healthy knee cartilage in rabbits. J Orthop Res 2010; 28 (06) 812-818
  • 36 Oestergaard S, Sondergaard BC, Hoegh-Andersen P. , et al. Effects of ovariectomy and estrogen therapy on type II collagen degradation and structural integrity of articular cartilage in rats: implications of the time of initiation. Arthritis Rheum 2006; 54 (08) 2441-2451
  • 37 Morisset S, Patry C, Lora M, de Brum-Fernandes AJ. Regulation of cyclooxygenase-2 expression in bovine chondrocytes in culture by interleukin 1alpha, tumor necrosis factor-alpha, glucocorticoids, and 17beta-estradiol. J Rheumatol 1998; 25 (06) 1146-1153
  • 38 Claassen H, Schünke M, Kurz B. Estradiol protects cultured articular chondrocytes from oxygen-radical-induced damage. Cell Tissue Res 2005; 319 (03) 439-445
  • 39 Bellido M, Lugo L, Roman-Blas JA. , et al. Subchondral bone microstructural damage by increased remodelling aggravates experimental osteoarthritis preceded by osteoporosis. Arthritis Res Ther 2010; 12 (04) R152
  • 40 Nevitt MC, Felson DT, Williams EN, Grady D. The effect of estrogen plus progestin on knee symptoms and related disability in postmenopausal women: the Heart and Estrogen/Progestin Replacement Study, a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2001; 44 (04) 811-818
  • 41 Odum SM, Springer BD, Dennos AC, Fehring TK. National obesity trends in total knee arthroplasty. J Arthroplasty 2013; 28 (8, Suppl): 148-151
  • 42 Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307 (05) 491-497
  • 43 Zyroul R, Hossain MG, Azura M, Abbas AA, Kamarul T. Knee laxity of Malaysian adults: gender differentials, and association with age and anthropometric measures. Knee 2014; 21 (02) 557-562
  • 44 Stryker Orthopedics. 2014 . Scorpio TS total knee revision system. Available at: http://www.stryker.com/enus/products/Orthopaedics/KneeReplacement/Revision/ScorpioTS/006362 . Accessed January 10, 2018
  • 45 Uvehammer J, Kärrholm J, Brandsson S. In vivo kinematics of total knee arthroplasty. Concave versus posterior-stabilised tibial joint surface. J Bone Joint Surg Br 2000; 82 (04) 499-505
  • 46 Salih S, Sutton P. Obesity, knee osteoarthritis and knee arthroplasty: a review. BMC Sports Sci Med Rehabil 2013; 5 (01) 25
  • 47 Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D. The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 2012; 94 (20) 1839-1844