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No justification for denying obese patients knee replacements
July 24, 2008Long term outcome following total knee arthoplasty: A controlled longitudinal study
There is no justification for denying obese patients knee replacement surgery: They benefit almost as much as anyone else from the procedure, concludes a small study published ahead of print in the Annals of the Rheumatic Diseases.
Around 55,000 knee replacements are performed every year in England to relieve the pain and disability of knee osteoarthritis.
But in some parts of the country the surgery is offered only to patients who are not clinically obese (body mass index (BMI) below 30 kg/m2), on the grounds that obesity is itself a risk factor for knee osteoarthritis.
The research team monitored the progress of 325 people over the age of 45 for around six years after they had had knee replacement surgery.
Their progress was compared with that of 363 general practice patients, matched for age and sex, who had not had knee replacements.
At the start and end of the study, all participants completed a validated questionnaire designed to assess their mobility, mental health and wellbeing (vitality).
To begin with, the patients said they had significantly worse mobility than those in the comparison group, scoring an average of 20 compared with 89.
By the end of the study, mobility in the patients had increased by an average of 6 points, while that in the comparison group had fallen by 14.
Mental health scores, which were similar at the outset, improved in both groups, but while wellbeing fell among both groups, the fall was greater among the patients who had had surgery.
When the researchers restricted their analysis to participants who were obese, the improvements persisted, and BMI did not appear to be a significant factor in this.
But there was a stark contrast in mobility among those who had and had not had the surgery.
Mobility score rose three points among those who had had surgery, but fell 36 points among those who had not had a knee replacement. And among those over the age of 75 who had not had the surgery, mobility score fell 40 points.
"The long term improvement in physical function that we observed in patients who have undergone TKA [knee replacement surgery] is striking when set against the decline that occurred in [the comparison group]," say the authors.
"These benefits extend to patients [who are obese] and, provided appropriate selection criteria are applied with regard to fitness for surgery, there seems no justification for withholding [knee replacement surgery] from patients who are obese," they conclude.
BMJ-British Medical Journal
But in some parts of the country the surgery is offered only to patients who are not clinically obese (body mass index (BMI) below 30 kg/m2), on the grounds that obesity is itself a risk factor for knee osteoarthritis.
The research team monitored the progress of 325 people over the age of 45 for around six years after they had had knee replacement surgery.
Their progress was compared with that of 363 general practice patients, matched for age and sex, who had not had knee replacements.
At the start and end of the study, all participants completed a validated questionnaire designed to assess their mobility, mental health and wellbeing (vitality).
To begin with, the patients said they had significantly worse mobility than those in the comparison group, scoring an average of 20 compared with 89.
By the end of the study, mobility in the patients had increased by an average of 6 points, while that in the comparison group had fallen by 14.
Mental health scores, which were similar at the outset, improved in both groups, but while wellbeing fell among both groups, the fall was greater among the patients who had had surgery.
When the researchers restricted their analysis to participants who were obese, the improvements persisted, and BMI did not appear to be a significant factor in this.
But there was a stark contrast in mobility among those who had and had not had the surgery.
Mobility score rose three points among those who had had surgery, but fell 36 points among those who had not had a knee replacement. And among those over the age of 75 who had not had the surgery, mobility score fell 40 points.
"The long term improvement in physical function that we observed in patients who have undergone TKA [knee replacement surgery] is striking when set against the decline that occurred in [the comparison group]," say the authors.
"These benefits extend to patients [who are obese] and, provided appropriate selection criteria are applied with regard to fitness for surgery, there seems no justification for withholding [knee replacement surgery] from patients who are obese," they conclude.
BMJ-British Medical Journal
Knee Replacement Current Events and Knee Replacement News RSSMarket based reforms have not harmed equity in the NHS, say researchers
Recent NHS reforms, such as the introduction of patient choice and provider competition, have not had a deleterious impact on equity with respect to waiting times for elective surgery in England.
Joint replacement patients with diabetes greatly benefit from controlled glucose
Diabetics undergoing total joint replacement often are at a higher risk of experiencing complications after surgery due to various pre-existing health conditions.
Total knee replacements increase mobility and motor skills in older patients
According to a new study from researchers at Duke University, total knee arthroplasty (TKA) procedures performed in older patients with osteoarthritis of the knee result in long-term, significant improvement of physical functioning and motor skills when compared to patients who do not receive TKA.
Severe obesity increases risks of health problems during surgery
Healthcare providers must carefully consider the unique risk factors related to severe obesity in patients undergoing all types of surgery, according to an American Heart Association scientific advisory published in Circulation: Journal of the American Heart Association.
Exercise after knee replacement critical
It may be uncomfortable at first, but doing exercises to strengthen your quadriceps after you've had knee replacement surgery due to osteoarthritis is critical to your recovery. In fact, it can boost the function of your new knee to nearly that of a healthy adult your age.
Research highlights new approaches to prevent blood clots
Blood clotting, or coagulation, is an important process that prevents excessive bleeding when a blood vessel is injured.
Nearly half of U.S. adults will develop painful knee osteoarthritis by age 85: study
Almost half of all U.S. adults and nearly two-thirds of obese adults will develop painful osteoarthritis of the knee by age 85, a study based at the University of North Carolina at Chapel Hill suggests.
How often do hip and knee replacements need revision?
A comprehensive study using nationwide data on hip and knee replacements in England has found that one in seventy-five patients require a revision of their joint replacement after three years.
New test to diagnose osteoarthritis early
A newly developed medical imaging technology may provide doctors with a long-awaited test for early diagnosis of osteoarthritis (OA), scientists from New York reported today at the 236th National Meeting of the American Chemical Society.
Research Examines Factors in Delaying or Declining Total Knee Replacement Surgery
A study led by Dr. Ann F. Jacobson, associate professor in Kent State's College of Nursing, unveils the reasons why people may initially choose to postpone but ultimately undergo total knee replacement surgery and emphasizes the need for better patient education before and after the procedure.
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