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J Knee Surg 2021; 34(09): 1026-1032
DOI: 10.1055/s-0040-1702932
Original Article

Does Body Mass Index Cause a Clinical Difference in Simultaneous Bilateral and Unilateral Knee Arthroplasty?

Hasan Ulas Ogur 
1   Department of Orthopaedics and Traumatology, Adana City Training and Research Hospital, Adana, Turkey
,
Hakan Cicek
1   Department of Orthopaedics and Traumatology, Adana City Training and Research Hospital, Adana, Turkey
,
Fırat Seyfettinoglu 
1   Department of Orthopaedics and Traumatology, Adana City Training and Research Hospital, Adana, Turkey
,
Ümit Tuhanioglu 
1   Department of Orthopaedics and Traumatology, Adana City Training and Research Hospital, Adana, Turkey
,
Ali Aydoğdu 
2   Department of Orthopaedics and Traumatology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
,
Kasım Kılıcarslan 
2   Department of Orthopaedics and Traumatology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
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Abstract

This study aims to investigate clinical and functional factors in patients undergoing unilateral and simultaneous bilateral total knee arthroplasty (TKA) who were classified into subgroups of nonobese, obese, and morbidly obese, and to determine perioperative and postoperative complications. We conducted an evaluation of 489 nonobese, obese, and morbidly obese patients who underwent TKA due to primary knee osteoarthritis between January 2006 and December 2013. The arthroplasties were performed by three different surgeons. Patients who underwent unilateral (group 1) or simultaneous bilateral (group 2) TKAs were divided into subgroups in accordance with BMI levels, that is, (a) nonobese (BMI < 30 kg/m2), (b) obese (BMI = 30–34.9 kg/m2), and (c) morbidly obese (BMI ≥35 kg/m2). Clinical and functional assessments were performed using Knee Society Scores (KSSs), the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and range of motion (ROM) values. Perioperative and early postoperative complications were assessed. The mean follow-up period was 46.65 months (minimum: 24 months; maximum: 84 months). There were no significant differences between the patients undergoing unilateral or simultaneous bilateral TKA procedures regarding postoperative ROM, WOMAC indices, and KSSs (p > 0.05), except for morbidly obese patients. Most intraoperative and early postoperative complications occurred in the morbidly obese group, especially in those undergoing simultaneous bilateral TKA procedures (p < 0.001). Unilateral and simultaneous bilateral TKA procedures showed no differences regarding ROM, clinical scores, and perioperative and early postoperative complications in nonobese and obese patients. A moderate increase was detected in complication rates in the unilateral TKA morbidly obese patients (group 1c); however, morbidly obese patients constituted the major risk group in simultaneous bilateral TKA patients (group 2c) regarding clinical scores (lower WOMAC scores and KSSs) and the development of complications.

Keywords

body mass index - unilateral total knee arthroplasty - bilateral total knee arthroplasty

Note

This study presented as an oral presentation at the National Turkish Orthopedics and Traumatology Congress.




Publication History

Received: 05 October 2018

Accepted: 07 January 2020

Article published online:
04 March 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Wang Y, Wluka AE, English DR. et al. Body composition and knee cartilage properties in healthy, community-based adults. Ann Rheum Dis 2007; 66 (09) 1244-1248
    CrossrefPubMedGoogle Scholar
  • 2 Sandmark H, Hogstedt C, Lewold S, Vingård E. Osteoarthrosis of the knee in men and women in association with overweight, smoking, and hormone therapy. Ann Rheum Dis 1999; 58 (03) 151-155
    CrossrefPubMedGoogle Scholar
  • 3 Roubenoff R. Applications of bioelectrical impedance analysis for body composition to epidemiologic studies. Am J Clin Nutr 1996; 64 (3, Suppl): 459S-462S
    CrossrefPubMedGoogle Scholar
  • 4 Cohen RG, Forrest CJ, Benjamin JB. Safety and efficacy of bilateral total knee arthroplasty. J Arthroplasty 1997; 12 (05) 497-502
    CrossrefPubMedGoogle Scholar
  • 5 Kim YH, Choi YW, Kim JS. Simultaneous bilateral sequential total knee replacement is as safe as unilateral total knee replacement. J Bone Joint Surg Br 2009; 91 (01) 64-68
    CrossrefPubMedGoogle Scholar
  • 6 Zhao YT, Chu HJ, Heng DF, Lei J. Comparison of the effectiveness and safety of one-stage versus two-stage bilateral total knee arthroplasty. Acta Orthop Belg 2015; 81 (04) 784-789
    PubMedGoogle Scholar
  • 7 Hart A, Antoniou J, Brin YS, Huk OL, Zukor DJ, Bergeron SG. Simultaneous bilateral versus unilateral total knee arthroplasty: A comparison of 30-day readmission rates and major complications. J Arthroplasty 2016; 31 (01) 31-35
    CrossrefPubMedGoogle Scholar
  • 8 Choi YJ, Lee HI, Ra HJ, Hwang DY, Kim TK, Shim SJ. Perioperative risk assessment in patients aged 75 years or older: Comparison between bilateral and unilateral total knee arthroplasty. Knee Surg Relat Res 2014; 26 (04) 222-229
    CrossrefPubMedGoogle Scholar
  • 9 Bini SA, Khatod M, Inacio MC, Paxton EW. Same-day versus staged bilateral total knee arthroplasty poses no increase in complications in 6672 primary procedures. J Arthroplasty 2014; 29 (04) 694-697
    CrossrefPubMedGoogle Scholar
  • 10 Ersozlu S, Akkaya T, Ozgur AF, Sahin O, Sentürk I, Tandoğan R. Bilateral staged total knee arthroplasty in obese patients. Arch Orthop Trauma Surg 2008; 128 (02) 143-148
    CrossrefPubMedGoogle Scholar
  • 11 Järvenpää J, Kettunen J, Kröger H, Miettinen H. Obesity may impair the early outcome of total knee arthroplasty. Scand J Surg 2010; 99 (01) 45-49
    CrossrefPubMedGoogle Scholar
  • 12 Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS. The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am 2004; 86 (08) 1609-1615
    CrossrefPubMedGoogle Scholar
  • 13 Zeni Jr. JA, Snyder-Mackler L. Clinical outcomes after simultaneous bilateral total knee arthroplasty: comparison to unilateral total knee arthroplasty and healthy controls. J Arthroplasty 2010; 25 (04) 541-546
    CrossrefPubMedGoogle Scholar
  • 14 Issa K, Pivec R, Kapadia BH. et al. Does obesity affect the outcomes of primary total knee arthroplasty?. J Knee Surg 2013; 26 (02) 89-94
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Roemer FW, Kwoh CK. et al. From early radiographic knee osteoarthritis to joint arthroplasty: determinants of structural progression and symptoms. Arthritis Care Res (Hoboken) 2018; 70 (12) 1778-1786
    CrossrefPubMedGoogle Scholar
  • 16 Gondusky JS, Choi L, Khalaf N, Patel J, Barnett S, Gorab R. Day of surgery discharge after unicompartmental knee arthroplasty: an effective perioperative pathway. J Arthroplasty 2014; 29 (03) 516-519
    CrossrefPubMedGoogle Scholar
  • 17 Yoon HS, Han CD, Yang IH. Comparison of simultaneous bilateral and staged bilateral total knee arthroplasty in terms of perioperative complications. J Arthroplasty 2010; 25 (02) 179-185
    CrossrefPubMedGoogle Scholar
  • 18 Guan Z, Chen Y, Song Y. [Influence of body mass index and age on deep vein thrombosis after total hip and knee arthroplasty] [Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2006; 20 (06) 611-615
    PubMedGoogle Scholar
  • 19 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
    PubMedGoogle Scholar
  • 20 Meehan JP, Danielsen B, Tancredi DJ, Kim S, Jamali AA, White RH. A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-bilateral total knee arthroplasty. J Bone Joint Surg Am 2011; 93 (23) 2203-2213
    CrossrefPubMedGoogle Scholar
  • 21 Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 2007; 89 (06) 1220-1226
    CrossrefPubMedGoogle Scholar
  • 22 Hooper GJ, Hooper NM, Rothwell AG, Hobbs T. Bilateral total joint arthroplasty: the early results from the New Zealand National Joint Registry. J Arthroplasty 2009; 24 (08) 1174-1177
    CrossrefPubMedGoogle Scholar
  • 23 Lindberg-Larsen M, Jørgensen CC, Husted H, Kehlet H. Early morbidity after simultaneous and staged bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23 (03) 831-837
    CrossrefPubMedGoogle Scholar
  • 24 Ritter MA, Harty LD, Davis KE, Meding JB, Berend M. Simultaneous bilateral, staged bilateral, and unilateral total knee arthroplasty. A survival analysis. J Bone Joint Surg Am 2003; 85 (08) 1532-1537
    CrossrefPubMedGoogle Scholar
  • 25 Stanley D, Stockley I, Getty CJ. Simultaneous or staged bilateral total knee replacements in rheumatoid arthritis. A prospective study. J Bone Joint Surg Br 1990; 72 (05) 772-774
    CrossrefPubMedGoogle Scholar
  • 26 Brotherton SL, Roberson JR, de Andrade JR, Fleming LL. Staged versus simultaneous bilateral total knee replacement. J Arthroplasty 1986; 1 (04) 221-228
    CrossrefPubMedGoogle Scholar
  • 27 Parvizi J, Sullivan TA, Trousdale RT, Lewallen DG. Thirty-day mortality after total knee arthroplasty. J Bone Joint Surg Am 2001; 83 (08) 1157-1161
    CrossrefPubMedGoogle Scholar
  • 28 Husted H, Jørgensen CC, Gromov K, Kehlet H. ; Lundbeck Foundation Center for Fast-track Hip and Knee Replacement Collaborative Group. Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty?. Acta Orthop 2016; 87 (05) 466-472
    CrossrefPubMedGoogle Scholar
  • 29 Gromov K, Kristensen BB, Jorgensen CC, Hansen TB, Kehlet H, Husted H. [Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting] [Dash]. Ugeskr Laeger 2017;179(38):
    PubMedGoogle Scholar
  • 30 Winiarsky R, Barth P, Lotke P. Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am 1998; 80 (12) 1770-1774
    CrossrefPubMedGoogle Scholar
  • 31 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
    CrossrefPubMedGoogle Scholar
  • 32 Meller MM, Toossi N, Johanson NA, Gonzalez MH, Son MS, Lau EC. Risk and cost of 90 day complications in morbidly and superobese patients after total knee arthroplasty. J Arthroplasty 2016; 31 (10) 2091-2098
    CrossrefPubMedGoogle Scholar
  • 33 Lozano LM, Núñez M, Segur JM. et al. Relationship between knee anthropometry and surgical time in total knee arthroplasty in severely and morbidly obese patients: a new prognostic index of surgical difficulty. Obes Surg 2008; 18 (09) 1149-1153
    CrossrefPubMedGoogle Scholar
  • 34 Lee GC, Lotke PA. Management of intraoperative medial collateral ligament injury during TKA. Clin Orthop Relat Res 2011; 469 (01) 64-68
    CrossrefPubMedGoogle Scholar
  • 35 Kokoszka P, Markuszewski J, Łapaj Ł, Kruczyński J. Knee function and subjective stability following total condylar arthroplasty in joints with preoperative varus or valgus deformity. Ortop Traumatol Rehabil 2015; 17 (05) 513-522
    CrossrefPubMedGoogle Scholar