SpringerLink
Log in

Body mass index changes after unicompartmental knee arthroplasty do not adversely influence patient outcomes

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The objective of this study is to evaluate the prevalence of patients who lost or gained weight following unicompartmental knee arthroplasty (UKA), the effect of post-operative body mass index (BMI) changes on functional outcomes and quality of life (QoL), and predictive factors associated with BMI changes.

Methods

Prospectively collected data of 1043 patients who underwent UKA between 2000 and 2014 were reviewed. BMI, Knee Society Knee Score and Function Score, Oxford Knee Score (OKS), Short-Form 36 (SF-36) Physical Component Score (PCS) and Mental Component Score and proportion of patients attaining OKS/SF-36 minimal clinically important differences (MCID) were recorded preoperatively and at 2 years post-operatively. The patients were stratified into three groups based on weight changes for further analysis.

Results

Following UKA, 138 (13.3%) patients had lost weight, 695 (66.6%) maintained their weight, and 210 (20.1%) gained weight. Patients in all groups demonstrated significant improvements in functional and SF-36 PCS scores at 2 years post-operatively. There were no significant differences in functional outcomes, QoL or revision rate between the groups. Post-operative BMI changes were not correlated with any outcome scores or attainment of MCID (n.s.).

Conclusions

This is the first study that evaluates change in BMI following UKA. It demonstrated a higher proportion of patients who gained weight as compared to those who lost weight. Post-operative BMI changes did not appear to affect outcomes of UKA. These findings will provide important information to surgeons when counselling patients regarding BMI change and its effect on outcomes after UKA.

Levels of evidence

Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anderson JJ, Felson DT (1988) Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. Am J Epidemiol 128:179–189

    Article  PubMed  CAS  Google Scholar 

  2. Ast MP, Abdel MP, Lee YY, Lyman S, Ruel AV, Westrich GH (2015) Weight changes after total hip or knee arthroplasty: prevalence, predictors, and effects on outcomes. J Bone Joint Surg Am 97:911–919

    Article  PubMed  Google Scholar 

  3. Berend KR, Lombardi AV Jr, Mallory TH, Adams JB, Groseth KL (2005) Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity. Clin Orthop Relat Res 440:60–66

    Article  PubMed  Google Scholar 

  4. Bin Abd Razak HR, Chong HC, Tan AH (2013) Obesity does not imply poor outcomes in Asians after total knee arthroplasty. Clin Orthop Relat Res 471:1957–1963

    Article  PubMed  Google Scholar 

  5. Chen JY, Lo NN, Chong HC, Bin Abd Razak HR, Pang HN, Tay DK et al (2016) The influence of body mass index on functional outcome and quality of life after total knee arthroplasty. Bone Joint J 98-B:780–785

    Article  PubMed  CAS  Google Scholar 

  6. Dowsey MM, Liew D, Stoney JD, Choong PF (2010) The impact of pre-operative obesity on weight change and outcome in total knee replacement: a prospective study of 529 consecutive patients. J Bone Joint Surg Br 92:513–520

    Article  PubMed  CAS  Google Scholar 

  7. Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I (2007) Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage 15:273–280

    Article  PubMed  CAS  Google Scholar 

  8. Formby PM, Purcell RL, Baird M, Wagner M, Goodlett RP, Mack AW (2017) No clinically meaningful weight changes in a young cohort following total joint arthroplasty at 3-year follow-up. ANZ J Surg 87:60–64

    Article  PubMed  Google Scholar 

  9. Gadinsky NE, Ehrhardt JK, Urband C, Westrich GH (2011) Effect of body mass index on range of motion and manipulation after total knee arthroplasty. J Arthroplasty 26:1194–1197

    Article  PubMed  Google Scholar 

  10. Gillespie GN, Porteous AJ (2007) Obesity and knee arthroplasty. Knee 14:81–86

    Article  PubMed  CAS  Google Scholar 

  11. Harding P, Holland AE, Delany C, Hinman RS (2014) Do activity levels increase after total hip and knee arthroplasty? Clin Orthop Relat Res 472:1502–1511

    Article  PubMed  Google Scholar 

  12. Heck DA, Marmor L, Gibson A, Rougraff BT (1993) Unicompartmental knee arthroplasty. A multicenter investigation with long-term follow-up evaluation. Clin Orthop Relat Res 286:154–159

    Google Scholar 

  13. Inacio MC, Kritz-Silverstein D, Paxton EW, Fithian DC (2013) Do patients lose weight after joint arthroplasty surgery? A systematic review. Clin Orthop Relat Res 471:291–298

    Article  PubMed  Google Scholar 

  14. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  15. Kahn HS, Cheng YJ (2008) Longitudinal changes in BMI and in an index estimating excess lipids among white and black adults in the United States. Int J Obes (Lond) 32:136–143

    Article  CAS  Google Scholar 

  16. Kandil A, Werner BC, Gwathmey WF, Browne JA (2015) Obesity, morbid obesity and their related medical comorbidities are associated with increased complications and revision rates after unicompartmental knee arthroplasty. J Arthroplasty 30:456–460

    Article  PubMed  Google Scholar 

  17. Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Joint Surg Am 71:145–150

    Article  PubMed  CAS  Google Scholar 

  18. Kuipers BM, Kollen BJ, Bots PC, Burger BJ, van Raay JJ, Tulp NJ et al (2010) Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 17:48–52

    Article  PubMed  Google Scholar 

  19. Liao CD, Huang YC, Lin LF, Huang SW, Liou TH (2015) Body mass index and functional mobility outcome following early rehabilitation after a total knee replacement: a retrospective study in Taiwan. Arthritis Care Res (Hoboken) 67:799–808

    Article  Google Scholar 

  20. Liow MH, Tsai TY, Dimitriou D, Li G, Kwon YM (2016) Does 3-dimensional in vivo component rotation affect clinical outcomes in unicompartmental knee arthroplasty? J Arthroplasty 31:2167–2172

    Article  PubMed  Google Scholar 

  21. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ et al (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89:1010–1014

    Article  PubMed  CAS  Google Scholar 

  22. Murray DW, Pandit H, Weston-Simons JS, Jenkins C, Gill HS, Lombardi AV et al (2013) Does body mass index affect the outcome of unicompartmental knee replacement? Knee 20:461–465

    Article  PubMed  CAS  Google Scholar 

  23. Naal FD, Neuerburg C, Salzmann GM, Kriner M, von Knoch F, Preiss S et al (2009) Association of body mass index and clinical outcome 2 years after unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 129:463–468

    Article  PubMed  Google Scholar 

  24. National Task Force on the P, Treatment of O (2000) Overweight, obesity, and health risk. Arch Intern Med 160:898–904

    Article  Google Scholar 

  25. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet 384:766–781

    Article  PubMed  PubMed Central  Google Scholar 

  26. Orpana HM, Tremblay MS, Fines P (2007) Trends in weight change among Canadian adults. Health Rep 18:9–16

    PubMed  Google Scholar 

  27. Paans N, Stevens M, Wagenmakers R, van Beveren J, van der Meer K, Bulstra SK et al (2012) Changes in body weight after total hip arthroplasty: short-term and long-term effects. Phys Ther 92:680–687

    Article  PubMed  Google Scholar 

  28. Plate JF, Augart MA, Seyler TM, Bracey DN, Hoggard A, Akbar M et al (2015) Obesity has no effect on outcomes following unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3597-5

    Article  PubMed  Google Scholar 

  29. Popkin BM, Adair LS, Ng SW (2012) Global nutrition transition and the pandemic of obesity in develo** countries. Nutr Rev 70:3–21

    Article  PubMed  PubMed Central  Google Scholar 

  30. Riddle DL, Singh JA, Harmsen WS, Schleck CD, Lewallen DG (2013) Clinically important body weight gain following knee arthroplasty: a five-year comparative cohort study. Arthritis Care Res (Hoboken) 65:669–677

    Article  Google Scholar 

  31. Sattar ABS, ur Rehman N, Bashir B (2013) Factors affecting BMI; Assessment of the effect of sociodemographic factors on BMI In the population of Ghulam Mohammad Abad Faisalabad. Prof Med J 20(6):956–964

    Google Scholar 

  32. Schwartsmann CR, Borges AM, Freitas GL, Migon EZ, Oliveira GK, Rodrigues MW (2017) Do patients lose weight after total knee replacement? Rev Bras Ortop 52:159–163

    Article  PubMed  PubMed Central  Google Scholar 

  33. Seng CS, Ho DC, Chong HC, Chia SL, Chin PL, Lo NN et al (2014) Outcomes and survivorship of unicondylar knee arthroplasty in patients with severe deformity. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3464-9

    Article  PubMed  Google Scholar 

  34. Si HB, Zeng Y, Shen B, Yang J, Zhou ZK, Kang PD et al (2015) The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:1824–1832

    Article  PubMed  Google Scholar 

  35. Singh J, Sloan JA, Johanson NA (2010) Challenges with health-related quality of life assessment in arthroplasty patients: problems and solutions. J Am Acad Orthop Surg 18:72–82

    Article  PubMed  PubMed Central  Google Scholar 

  36. Song EK, Mohite N, Lee SH, Na BR, Seon JK (2016) Comparison of outcome and survival after unicompartmental knee arthroplasty between navigation and conventional techniques with an average 9-year follow-up. J Arthroplasty 31:395–400

    Article  PubMed  Google Scholar 

  37. Stommel M, Schoenborn CA (2009) Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001–2006. BMC Public Health 9:421

    Article  PubMed  PubMed Central  Google Scholar 

  38. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML et al (2011) The global obesity pandemic: shaped by global drivers and local environments. Lancet 378:804–814

    Article  PubMed  Google Scholar 

  39. Teichtahl AJ, Quirk E, Harding P, Holland AE, Delany C, Hinman RS et al (2015) Weight change following knee and hip joint arthroplasty-a six-month prospective study of adults with osteoarthritis. BMC Musculoskelet Disord 16:137

    Article  PubMed  PubMed Central  Google Scholar 

  40. Teichtahl AJ, Wluka AE, Tanamas SK, Wang Y, Strauss BJ, Proietto J et al (2015) Weight change and change in tibial cartilage volume and symptoms in obese adults. Ann Rheum Dis 74:1024–1029

    Article  PubMed  CAS  Google Scholar 

  41. Tsai TY, Dimitriou D, Hosseini A, Liow MH, Torriani M, Li G et al (2016) Assessment of accuracy and precision of 3D reconstruction of unicompartmental knee arthroplasty in upright position using biplanar radiography. Med Eng Phys 38:633–638

    Article  PubMed  Google Scholar 

  42. van der List JP, Chawla H, Zuiderbaan HA, Pearle AD (2016) The role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: a meta-analysis critique. J Arthroplasty 31:2617–2627

    Article  PubMed  Google Scholar 

  43. Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study. Med Care 33:AS264–AS279

    Article  PubMed  Google Scholar 

  44. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  45. Ware JEKM, Keller SD (1994) SF-36 physical and mental health summary scales: a user’s manual. Health Institute, New England Medical Center, Boston

    Google Scholar 

  46. **ng Z, Katz J, Jiranek W (2012) Unicompartmental knee arthroplasty: factors influencing the outcome. J Knee Surg 25:369–373

    Article  PubMed  Google Scholar 

  47. Zengerink I, Duivenvoorden T, Niesten D, Verburg H, Bloem R, Mathijssen N (2015) Obesity does not influence the outcome after unicompartmental knee arthroplasty. Acta Orthop Belg 81:776–783

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Zhan **a and Ming Han Lincoln Liow have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Zhan **a, Ming Han Lincoln Liow, Graham Seow-Hng Goh, Hwei Chi Chong, Ngai Nung Lo & Seng ** Yeo

Authors
  1. Zhan **a
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ming Han Lincoln Liow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Graham Seow-Hng Goh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hwei Chi Chong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ngai Nung Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seng ** Yeo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhan **a.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not for-profit sectors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

**a, Z., Liow, M.H.L., Goh, G.SH. et al. Body mass index changes after unicompartmental knee arthroplasty do not adversely influence patient outcomes. Knee Surg Sports Traumatol Arthrosc 26, 1691–1697 (2018). https://doi.org/10.1007/s00167-017-4703-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4703-7

Keywords

Search

Navigation