A comprehensive comparative study on mid-term clinical and functional outcomes in Indian patients following bilateral total knee arthroplasty: assessing the impact of body mass index on post-total knee arthroplasty results
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20240687Keywords:
Bilateral total knee arthroplasty, Cruciate retaining/posterior stabilized total knee system, Body mass index, Obesity, Range of motion, RadiographyAbstract
Background: Limited research exists on Indian obese patients undergoing simultaneous bilateral total knee arthroplasty (bTKA), necessitating a comprehensive and comparative analysis with non-obese counterparts. This study presents an observational and prospective assessment of Indian patients who underwent cruciate retaining/posterior stabilized (CR/PS) metal-backed implant surgeries from 2016 to 2019.
Methods: The study encompassed 190 patients (380 knees) undergoing bTKA, classified by World Health Organization (WHO) weight stratification: normal weight (cohort 1, n=51), overweight (cohort 2, n=85), and obese (cohort 3, n=54). Primary endpoints were implant survivorship and revision rates, with secondary endpoints including range of motion (ROM), knee society score (KSS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and SF-36 scores.
Results: Female representation dominated all groups (88.24%, 87.06%, and 90.74%). End-stage osteoarthritis occurred in 94.12%, 96.47%, and 98.15%, respectively. Over the 3-year follow-up, four fatalities occurred, with 186 patients completing the study. ROM showed significant improvement after three years, with baseline values increasing from 93.29°±18.29° (cohort 1) to 123.97°±2.28°, 122.86°±5.03°, and 122.67°±4.77°, respectively (p<0.001). KSS demonstrated substantial improvement (cohort 1: 89.87±6.48, cohort 2: 90.47±8.40, cohort 3: 90.52±8.07) after three years. A 100% success rate and no revisions indicated implant durability. WOMAC and SF-36 questionnaires exhibited significant improvements in pain, stiffness, and overall well-being (p<0.001) after bTKA.
Conclusions: This mid-term CR/PS knee survival analysis underscores 100% implant functionality, improved knee function, and enhanced quality of life for all patients, irrespective of their body mass index (BMI). Simultaneous bilateral TKA with CR/PS implants demonstrates favourable outcomes, affirming its efficacy as a viable treatment option.
References
Remily EA, Mohamed NS, Wilkie WA, Smith T, Judice A, Forte S, et al. Obesity and its effect on outcomes in same-day bilateral total knee arthroplasty. Ann Transl Med. 2020;8(15):936.
Parvizi J, Rasouli MR. Simultaneous-bilateral TKA: double trouble - affirms. J Bone Joint Surg Br. 2012;94(11):90-2.
Trojani C, Bugnas B, Blay M, Carles M, Boileau P. Bilateral total knee arthroplasty in a one-stage surgical procedure. Orthop Traumatol Surg Res. 2012;98(8):857-62.
Santana DC, Anis HK, Mont MA, Higuera CA, Piuzzi NS. What is the Likelihood of Subsequent Arthroplasties after Primary TKA or THA? Data from the Osteoarthritis Initiative. Clin Orthop Relat Res. 2020;478(1):34-41.
Agarwala S, Wagh YS, Vijayvargiya M. Is obesity a contraindication for simultaneous bilateral total knee arthroplasty? A prospective case-control study. SICOT J. 2020;6:42.
Ishii Y, Noguchi H, Sato J, Ishii H, Ishii R, Toyabe SI. Predictive factors for longer operative times in patients with medial knee osteoarthritis undergoing total knee arthroplasty. J Orthop. 2020;20:181-5.
Tio M, Basora M, Rios J, Sanchez-Etayo G, Berge R, Sastre S, et al. Severe and morbid obesity and transfusional risk in total knee arthroplasty: An observational study. Knee. 2018;25(5):923-31.
Cao G, Chen G, Yang X, Huang Q, Huang Z, Xu H, et al. Obesity does not increase blood loss or incidence of immediate postoperative complications during simultaneous total knee arthroplasty: A multicenter study. The Knee. 2020;27(3):963-9.
Szoeke C, Dennerstein L, Guthrie J, Clark M, Cicuttini F. The relationship between prospectively assessed body weight and physical activity and prevalence of radiological knee osteoarthritis in postmenopausal women. J Rheumatol. 2006;33(9):1835-40.
Anandacoomarasamy A, Fransen M, March L. Obesity and the musculoskeletal system. Curr Opin Rheumatol. 2009;21(1):71-7.
Durbhakula S, Rego LF. Restoration of Femoral Condylar Anatomy for Achieving Optimum Functional Expectations: Component Design and Early Results. Reconstruct Rev. 2016;6(3).
Durbhakula S, Durbhakula VS, Durbhakula NS. Restoration of Femoral Condylar Anatomy for Achieving Optimum Functional Expectations: Continuation of an Earlier Study At 5-Year Minimum Follow-Up. Reconstruct Rev. 2019;9(1).
Londhe SB, Shah RV, Khot R, Desouza C. Early Results of Bone-Conserving High Flexion Posterior-Stabilized Total Knee System in Indian Population. Indian J Orthop. 2022;56(10):1759-66.
Luscombe JC, Theivendran K, Abudu A, Carter SR. The relative safety of one-stage bilateral total knee arthroplasty. Int Orthop. 2009;33(1):101-4.
Chan SK, Opanova MI, Thorne TJ, Matsumoto MY, Andrews SN, Nakasone CK. Can obese patients undergo simultaneous bilateral total knee arthroplasty without an increased risk of perioperative complications? J Orthop. 2021;27:137-40.
Spicer DD, Pomeroy DL, Badenhausen WE, Schaper LA, Jr., Curry JI, Suthers KE, et al. Body mass index as a predictor of outcome in total knee replacement. Int Orthop. 2001;25(4):246-9.
Griffin FM, Scuderi GR, Insall JN, Colizza W. Total knee arthroplasty in patients who were obese with 10 years followup. Clin Orthop Relat Res. 1998;(356):28-33.
Amin AK, Patton JT, Cook RE, Brenkel IJ. Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Br. 2006;88(3):335-40.
Meehan JP, Danielsen B, Tancredi DJ, Kim S, Jamali AA, White RH. A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-bilateral total knee arthroplasty. J Bone Joint Surg Am. 2011;93(23):2203-13.
Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007;89(6):1220-6.
Bini SA, Khatod M, Inacio MC, Paxton EW. Same-day versus staged bilateral total knee arthroplasty poses no increase in complications in 6672 primary procedures. J Arthroplasty. 2014;29(4):694-7.
Hooper GJ, Hooper NM, Rothwell AG, Hobbs T. Bilateral total joint arthroplasty: the early results from the New Zealand National Joint Registry. J Arthroplasty. 2009;24(8):1174-7.
