Higher Body Mass Index Leads to Longer Operative Time in Total

Knee Arthroplasty
Barthelemy Liabaud MD, David A. Patrick Jr. BS, Jeffrey A. Geller MD

Deals with a retrospective registry cohort

273 patients
Operative time first incision to last suture
Almost female 61.2% obesity overall
Describes increased complication rate for
obese but does not describe their comorbidities and so could be attributed to
other factors.
Significant difference in operative time
between normal and obese groups I-III but
not overweight.
Did not demonstrate difference in WOMAC
or SF12 scores.
Arthrofibrosis even across groups, wound
infection preponderant in obese patients.
AND in this cohort the obese group were
significantly younger by 6.41 years

Quantifying Cardiovascular Risks in Patients

With Metabolic Syndrome Undergoing Total
Joint Arthroplasty
Kishor Gandhi, MD, MPH,* Eugene R. Viscusi, MD,* Eric S. Schwenk, MD,*
Luis Pulido, MD,y and Javad Parvizi, MDy

Retrospective Cohort 8157 TJA over three

years
1132 had met synd 13% (would be 25% in
gen pop)
3000 controls chosen who did NOT have Met
Synd
Modified definition of Met Synd presence
of 3 or more of DM, Dyslip, HTN, Obesity
Obesity alone is not statistically significant
for cv complications
Says cumulative incidence of CV
complications is 4.3% in Met synd vs 3.1% in
controls but doesnt give actual figures or pvalues etc for individual complications
gives them as a pooled bivariate and says pval is .028 for this the only individual

cardiovascular outcome that is given an

individual p-value is PE and it is <0.05.

Again says that further regression analysis

shows that for those with 3 or 4 factors the
OR of cardiovascular complications is
increased, however, the 95% CI for each of
these comes very close to 1.

Interestingly, only 14.7% of the cohort with

Met Synd here were obese, compared to a
much higher prevalence in the general
populous.

Total knee replacement in morbidly

obese patients
RESULTS OF A PROSPECTIVE, MATCHED STUDY
A. K. Amin, R. A. E. Clayton, J. T. Patton,M. Gaston, R. E. Cook, I. J. Brenkel

Prospective study
N = 41 TKR in 38 patients BMI >40, 41 TKRs
in 38 patients with BMI <30 groups well
matched.

F/U from 6-66 months, mean 38.5, none lost

to f/u
Inferior Knee Society Score in obese group
85.7 vs 90.5 but not significant
Inferior function score 75.6 vs 83.4
Incidence of radiolucent lines? 29 vs 7 %
32% obese had complications vs 0% in
control group
Survival without revision was 74.2% in
obese at five years compared to 100% in
controls
Revision and pain as end point 5yi was
72.3% and 97.6% respectively. P 0.02

What if the surgeon specialised in TKR for

morbidly obese patients? could this be
overcome? Are there specific identifiable
technical problems that can be overcome?

PREDICTORS OF INTENSIVE CARE UNIT

ADMISSION AFTER TOTAL JOINT
ARTHROPLASTY
Hossam AbdelSalam, MD, Camilo Restrepo, MD, T. David Tarity, MD,
William Sangster, BS, and Javad Parvizi, MD, FRCS

Case Control study 22343 TJAs performed

130 admitted to ICU 0.6% rate of ICU
admission
These were matched 2:1 against 260
patients who were not admitted to ICU, who
had operations about the same time, and
were performed by the same surgeon.
Multivariate analysis demonstrates several
variables as significant for risk of ICU
admission.
Smoking, GA, Cemented, Lower Hb,
Smoking, Higher transfusion, Higher pre-op
CRP, Higher BMI, Higher Age.

Most significant were smoking and

cemented arthroplasty with smokers being
65 times more likely than non smokers to be
admitted to ICU in the postoperative period.

All knees in this study were cemented, and

of this group 70 had complications requiring
ICU admission. Whereas of the 60 Total Hip
Arthroplasty patients who developed
complications requiring ICU admission, 35
had cementless implants and 25 were
cemented.

General anaesthesia was associated with a

45 times higher likelihood of needing post
op ICU admission.

Intra-operative blood transfusion

requirement was another risk factor for
admission to ICU 3.5 times more likely to
be admitted.

BMI only marginally increased risk of

admission to ICU

 Odds ratio of 1.1 with 95% CI of 1.01 to

1.18 p .015