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Effect of Weight Change on Patient-Reported Outcomes Following Total Joint Arthroplasty

      Abstract

      Background

      Increased body mass index (BMI) has been previously described as a risk factor for complications after total joint arthroplasty (TJA); however, its effect on patient-reported outcomes has not been thoroughly investigated. This study examines the effect of postoperative weight change on the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) scores for total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients.

      Methods

      A retrospective review of 988 patients undergoing THA or TKA was performed. PROMIS-PF scores and BMI were recorded throughout the study duration. Patients were classified by a 5% change in BMI. A univariate analysis evaluated differences across groups. Mixed-effect models evaluated predictors of change in functional score over the postoperative follow-up time.

      Results

      43.1% patients had a THA and 56.9% patients had a TKA. At 0 to 3 months, 92% of patients had no change in BMI, 3 to 6 months 82% had no change, and 6 to 12 months 80% had no change. There were no significant demographic or comorbidity differences across groups for both THA and TKA. Similar improvements in PROMIS-PF scores were observed across weight change groups. In the mixed-effect models, postoperative time was found to be a significant predictor of postoperative PF score. Both THA and TKA patients saw greater improvements in PROMIS-PF scores in patients with lower preoperative BMIs.

      Conclusion

      These results demonstrate most patients do not experience substantial changes in weight following TJA. However, lower BMIs at the time of surgery were associated with an increased functional improvement. Therefore, efforts to optimize BMI should be focused preoperatively to improve surgical outcomes.

      Keywords

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      References

        • Etkin C.D.
        • Springer B.D.
        The American joint replacement registry-the first 5 years.
        Arthroplast Today. 2017; 3: 67-69
        • Ward D.T.
        • Metz L.N.
        • Horst P.K.
        • Kim H.T.
        • Kuo A.C.
        Complications of morbid obesity in total joint arthroplasty: risk stratification based on BMI.
        J Arthroplasty. 2015; 30: 42-46
        • Katz J.N.
        • Arant K.R.
        • Loeser R.F.
        Diagnosis and treatment of hip and knee osteoarthritis: a review.
        JAMA. 2021; 325: 568-578
        • Centers for Disease Control and Prevention
        The health effects of overweight and obesity.
        ([accessed 13.04.22])
        • Health U.
        Obesity treatments.
        ([accessed 13.04.22])
        • Cella D.
        • Hahn E.A.
        • Jensen S.E.
        • Butt Z.
        • Nowinski C.J.
        • Rothrock N.
        • et al.
        Patient-Reported Outcomes in Performance Measurement.
        RTI Press, Research Triangle Park, NC2015 (Types of Patient-Reported Outcomes)
        • Broderick J.E.
        • DeWitt E.M.
        • Rothrock N.
        • Crane P.K.
        • Forrest C.B.
        Advances in patient-reported outcomes: the NIH PROMIS((R)) measures.
        EGEMS (Wash DC). 2013; 1: 1015
        • Inacio M.C.
        • Silverstein D.K.
        • Raman R.
        • Macera C.A.
        • Nichols J.F.
        • Shaffer R.A.
        • et al.
        Weight patterns before and after total joint arthroplasty and characteristics associated with weight change.
        Perm J. 2014; 18: 25-31
        • Stets K.
        • Koehler S.M.
        • Bronson W.
        • Chen M.
        • Yang K.
        • Bronson M.
        Weight and body mass index change after total joint arthroplasty.
        Orthopedics. 2010; 33: 386
        • Jameson S.S.
        • Mason J.M.
        • Baker P.N.
        • Elson D.W.
        • Deehan D.J.
        • Reed M.R.
        The impact of body mass index on patient reported outcome measures (PROMs) and complications following primary hip arthroplasty.
        J Arthroplasty. 2014; 29: 1889-1898
        • Katakam A.
        • Collins A.K.
        • Sauder N.
        • Shin D.
        • Bragdon C.R.
        • Chen A.F.
        • et al.
        Obesity increases risk of failure to achieve the 1-year PROMIS PF-10a minimal clinically important difference following total joint arthroplasty.
        J Arthroplasty. 2021; 36: S184-S191
        • Kiran A.
        • Bottomley N.
        • Biant L.C.
        • Javaid M.K.
        • Carr A.J.
        • Cooper C.
        • et al.
        Variations in good patient reported outcomes after total knee arthroplasty.
        J Arthroplasty. 2015; 30: 1364-1371
        • Turcotte J.
        • Kelly M.
        • Aja J.
        • King P.
        • MacDonald J.
        Complication rates and resource utilization after total hip and knee arthroplasty stratified by body mass index.
        J Orthop. 2021; 24: 111-120
        • Zusmanovich M.
        • Haselman W.
        • Serrano B.
        • Banffy M.
        The incidence of hip arthroscopy in patients with femoroacetabular impingement syndrome and labral pathology increased by 85% between 2011 and 2018 in the United States.
        Arthroscopy. 2022; 38: 82-87
        • Alvi H.M.
        • Mednick R.E.
        • Krishnan V.
        • Kwasny M.J.
        • Beal M.D.
        • Manning D.W.
        The effect of BMI on 30 day outcomes following total joint arthroplasty.
        J Arthroplasty. 2015; 30: 1113-1117
        • George J.
        • Piuzzi N.S.
        • Ng M.
        • Sodhi N.
        • Khlopas A.A.
        • Mont M.A.
        Association between body mass index and thirty-day complications after total knee arthroplasty.
        J Arthroplasty. 2018; 33: 865-871
        • Mackie A.
        • Muthumayandi K.
        • Shirley M.
        • Deehan D.
        • Gerrand C.
        Association between body mass index change and outcome in the first year after total knee arthroplasty.
        J Arthroplasty. 2015; 30: 206-209
        • Teichtahl A.J.
        • Quirk E.
        • Harding P.
        • Holland A.E.
        • Delany C.
        • Hinman R.S.
        • et al.
        Weight change following knee and hip joint arthroplasty-a six-month prospective study of adults with osteoarthritis.
        BMC Musculoskelet Disord. 2015; 16: 137
        • Jones C.A.
        • Cox V.
        • Jhangri G.S.
        • Suarez-Almazor M.E.
        Delineating the impact of obesity and its relationship on recovery after total joint arthroplasties.
        Osteoarthritis Cartilage. 2012; 20: 511-518
        • Seward M.W.
        • Briggs L.G.
        • Bain P.A.
        • Chen A.F.
        Preoperative nonsurgical weight loss interventions before total hip and knee arthroplasty: a systematic review.
        J Arthroplasty. 2021; 36: 3796-3806.e8
        • Liljensoe A.
        • Laursen J.O.
        • Bliddal H.
        • Søballe K.
        • Mechlenburg I.
        Weight loss intervention before total knee replacement: a 12-month Randomized Controlled Trial.
        Scand J Surg. 2021; 110: 3-12
        • Lingamfelter M.
        • Orozco F.R.
        • Beck C.N.
        • Harrer M.F.
        • Post Z.D.
        • Ong A.C.
        • et al.
        Nutritional counseling program for morbidly obese patients Enables weight Optimization for Safe total joint arthroplasty.
        Orthopedics. 2020; 43: e316-e322
        • López-Gómez J.J.
        • Izaola-Jauregui O.
        • Torres-Torres B.
        • Gómez-Hoyos E.
        • Castro Lozano M.Á.
        • Ortolá-Buigues A.
        • et al.
        Influence of a meal-replacement diet on quality of life in women with obesity and knee osteoarthritis before orthopedic surgery.
        Nutr Hosp. 2018; 35: 71-77