Dataset Information

Effect of body mass index on duration of total knee replacement surgery: A prospective cross sectional study

ABSTRACT:

Introduction

Obesity and increased BMI has raised concerns throughout the globe. As obesity is often associated with many serious medical conditions. Obesity, older age and gender are major contributing factors for knee replacement surgeries. We aimed to compare the mean duration of surgery in obese and non-obese patients undergoing total knee replacement.

Methods

A Cross-sectional study is conducted at the orthopedic department at Shifa international hospital, Islamabad during June 2021–Dec 2021. Study is conducted to assess the effect of BMI on duration of total knee arthroplasty. Sample size was calculated to be 105 with 95% confidence limit. Data will be analyzed using SPSS version 22. Quantitative variables like age, BMI and duration of surgery were presented as mean and standard deviation. Qualitative variables like gender, laterality (unilateral/bilateral), and ASA were presented as frequency and percentage.

Results

There were more females undergoing the procedure than males. The predominant age group was found to be 56–65 years. On BMI classification scale, a far greater number of individuals were found to be obese constituting more than ⅗ of the study population and almost ⅕ of the patients were overweight. The Association of BMI Classification & Duration of Surgery has a significant p value of 0.00.

Conclusion

A linear and direct relation was observed between body mass index and duration of surgery. There may be other contributing factors and will need more data and research. Highlights • The body mass index (BMI) is widely recognized as a prognostic factor in multiple operations.• High body mass index (BMI) is associated with increased rates of complications after total knee arthroplasty.• Our study finds a strong association of Age, Gender & ASA Grade with BMI.

SUBMITTER: Abbas Z

PROVIDER: S-EPMC9577639 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Project description:BackgroundTotal knee replacement (TKR) is an effective and cost-effective strategy for treating end-stage knee osteoarthritis. Greater risk for complications among TKR recipients with a body mass index (BMI) of 40 kg/m2 or greater has raised concerns about the value of TKR in this population.ObjectiveTo assess the value of TKR in recipients with a BMI of 40 kg/m2 or greater using a cost-effectiveness analysis.DesignOsteoarthritis Policy Model to assess long-term clinical benefits, costs, and cost-effectiveness of TKR in patients with a BMI of 40 kg/m2 or greater.Data sourcesTotal knee replacement parameters from longitudinal studies and published literature, and costs from Medicare Physician Fee Schedules, the Healthcare Cost and Utilization Project, and published data.Target populationRecipients of TKR with a BMI of 40 kg/m2 or greater in the United States.Time horizonLifetime.PerspectiveHealth care sector.InterventionTotal knee replacement.Outcome measuresCost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually.Results of base-case analysisTotal knee replacement increased QALYs by 0.71 year and lifetime medical costs by $25 200 among patients aged 50 to 65 years with a BMI of 40 kg/m2 or greater, resulting in an ICER of $35 200. Total knee replacement in patients older than 65 years with a BMI of 40 kg/m2 or greater increased QALYs by 0.39 year and costs by $21 100, resulting in an ICER of $54 100.Results of sensitivity analysisIn TKR recipients with a BMI of 40 kg/m2 or greater and diabetes and cardiovascular disease, ICERs were below $75 000 per QALY. Results were most sensitive to complication rates and preoperative pain levels. In the probabilistic sensitivity analysis, at a $55 000-per-QALY willingness-to-pay threshold, TKR had a 100% and 90% likelihood of being a cost-effective strategy for patients aged 50 to 65 years and patients older than 65 years, respectively.LimitationData are derived from several sources.ConclusionFrom a cost-effectiveness perspective, TKR offers good value in patients with a BMI of 40 kg/m2 or greater, including those with multiple comorbidities.Primary funding sourceNational Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.

Project description:BACKGROUND:Gait analysis can be used to measure variations in joint function in patients with knee osteoarthritis (OA), and is useful when observing longitudinal biomechanical changes following Total Knee Replacement (TKR) surgery. The Cardiff Classifier is an objective classification tool applied previously to examine the extent of biomechanical recovery following TKR. In this study, it is further developed to reveal the salient features that contribute to recovery towards healthy function. METHODS:Gait analysis was performed on 30 patients before and after TKR surgery, and 30 healthy controls. Median TKR follow-up time was 13 months. The combined application of principal component analysis (PCA) and the Cardiff Classifier defined 18 biomechanical features that discriminated OA from healthy gait. Statistical analysis tested whether these features were affected by TKR surgery and, if so, whether they recovered to values found for the controls. RESULTS:The Cardiff Classifier successfully discriminated between OA and healthy gait in all 60 cases. Of the 18 discriminatory features, only six (33%) were significantly affected by surgery, including features in all three planes of the ground reaction force (p<0.001), ankle dorsiflexion moment (p<0.001), hip adduction moment (p = 0.003), and transverse hip angle (p = 0.007). All but two (89%) of these features remained significantly different to those of the control group after surgery. CONCLUSIONS:This approach was able to discriminate gait biomechanics associated with knee OA. The ground reaction force provided the strongest discriminatory features. Despite increased gait velocity and improvements in self-reported pain and function, which would normally be clinical indicators of recovery, the majority of features were not affected by TKR surgery. This TKR cohort retained pre-operative gait patterns; reduced sagittal hip and knee moments, decreased knee flexion, increased hip flexion, and reduced hip adduction. The changes that were associated with surgery were predominantly found at the ankle and hip, rather than at the knee.