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Biomet - changing the rules of total knee replacement
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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 10, 1321-1326.
doi: 10.1302/0301-620X.88B10.17697  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Total knee replacement in morbidly obese patients

RESULTS OF A PROSPECTIVE, MATCHED STUDY

A. K. Amin, MRCS(Ed), Specialist Registrar1; R. A. E. Clayton, MRCS(Ed), Specialist Registrar1; J. T. Patton, FRCS(Ed), Consultant Orthopaedic Surgeon2; M. Gaston, MRCS(Ed), Specialist Registrar1; R. E. Cook, FRCS(Ed), Consultant Orthopaedic Surgeon1; and I. J. Brenkel, FRCS, Consultant Orthopaedic Surgeon1

1 Department of Orthopaedics, Queen Margaret Hospital, Whitefield Road, Dunfermline KY12 0SU, UK.
2 Department of Orthopaedics, New Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK.

Correspondence should be sent to Mr A. K. Amin; e-mail: Anish_Amin{at}yahoo.com

The results of 41 consecutive total knee replacements performed on morbidly obese patients with a body mass index > 40 kg/m2, were compared with a matched group of 41 similar procedures carried out in non-obese patients (body mass index < 30 kg/m2). The groups were matched for age, gender, diagnosis, type of prosthesis, laterality and pre-operative Knee Society Score. We prospectively followed up the patients for a mean of 38.5 months (6 to 66). No patients were lost to follow-up. At less than four years after operation, the results were worse in the morbidly obese group compared with the non-obese, as demonstrated by inferior Knee Society Scores (mean knee score 85.7 and 90.5 respectively, p = 0.08; mean function score 75.6 and 83.4, p = 0.01), a higher incidence of radiolucent lines on post-operative radiographs (29% and 7%, respectively, p = 0.02), a higher rate of complications (32% and 0%, respectively, p = 0.001) and inferior survivorship using revision and pain as end-points (72.3% and 97.6%, respectively, p = 0.02).

Patients with a body mass index > 40 kg/m2 should be advised to lose weight prior to total knee replacement and to maintain weight reduction. They should also be counselled regarding the inferior results which may occur if they do not lose weight before surgery.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General