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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 8, 1044-1048.
doi: 10.1302/0301-620X.91B8.22129  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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The impact of obesity on the mid-term outcome of cementless total knee replacement

M. P. Jackson, FRCS(Tr & Orth), Arthroplasty Fellow1; S. A. Sexton, FRCS(Tr & Orth), Arthroplasty Fellow1; W. L. Walter, PhD, FRACS, Consultant Orthopaedic Surgeon1; W. K. Walter, FRACS, Consultant Orthopaedic Surgeon1; and B. A. Zicat, MD, FRACS, Consultant Orthopaedic Surgeon1

1 Sydney Hip & Knee Surgeons, Level 3, 100 Bay Road, Waverton, Sydney, New South Wales 2060, Australia.

Correspondence should be sent to Mr M. P. Jackson; e-mail: mrmark.jackson{at}btinternet.com

We evaluated 535 consecutive primary cementless total knee replacements (TKR). The mean follow-up was 9.2 years (0.3 to 12.9) and information on implant survival was available for all patients. Patients were divided into two groups: 153 obese patients (BMI ≥ 30) and 382 non-obese (BMI < 30). A case-matched study was performed on the clinical and radiological outcome, comparing 50 knees in each group. We found significantly lower mean improvements in the clinical score (p = 0.044) and lower post-operative total clinical scores in the obese group (p = 0.041). There was no difference in the rate of radiological osteolysis or lucent lines, and no difference in alignment. Log rank test for survival showed no significant differences between the groups (p = 0.167), with a ten-year survival rate of 96.4% (95% confidence interval (CI) 92 to 99) in the obese and 98% (95% CI 96 to 99) in the non-obese.

The mid-term survival of TKR in the obese and the non-obese are comparable, but obesity appears to have a negative effect on the clinical outcome. However, good results and high patient satisfaction are still to be expected, and it would seem unreasonable to deny patients a TKR simply on the basis of a BMI indicating obesity.






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