Highlights
- •Osteoarthritis is a leading cause of disability. The knee joint is most commonly affected.
- •There is an association between obesity and knee osteoarthritis.
- •Rising obesity trends result in more total knee arthroplasty (TKA).
- •Obese patients can benefit from TKA despite higher risks and more uncertain outcomes.
- •A high body mass index (BMI) should not be an absolute contraindication to knee replacement.
Abstract
This paper provides an up-to-date review of obesity and lower limb osteoarthritis
(OA). OA is a major global cause of disability, with the knee being the most frequently
affected joint. There is a proven association between obesity and knee OA, and obesity
is suggested to be the main modifiable risk factor. Obese patients (Body Mass Index,
BMI, over 30 kg/m2) are more likely to require total knee arthroplasty (TKA). The global prevalence
of obesity has doubled since 1980; by 2025, 47% of UK men and 36% of women are forecast
to be obese. This rising global burden is a key factor in the growing rise in the
use of TKA. It is therefore important to appreciate the outcomes of surgery in patients
with end-stage OA and a high BMI.
This review found that while OA is felt to contribute to weight gain, it is unclear
whether TKA facilitates weight reduction. Surgery in obese patients is more technically
challenging. This is reflected in the evidence, which suggests higher rates of short-
to medium-term complications following TKA, including wound infection and medical
complications, resulting in longer hospital stay, and potentially higher rates of
malalignment, dislocation, and early revision. However, despite slower initial recovery
and possibly lower functional scores and implant survival in the longer term, obese
patients can still benefit from TKA in terms of improved function, quality of life
and satisfaction.
In conclusion, despite higher risks and more uncertain outcomes of surgery, higher
BMI in itself should not be a contraindication to TKA; instead, each patient’s individual
circumstances should be considered.
Keywords
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Article info
Publication history
Published online: April 11, 2016
Accepted:
April 8,
2016
Received:
April 4,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
