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Review
. 2022 May 5;7(5):295-304.
doi: 10.1530/EOR-21-0090.

Mid- to long-term complications and outcome for morbidly obese patients after total knee arthroplasty: a systematic review and meta-analysis

Joost van Tilburg  1 , Mikkel Rathsach Andersen  1
Affiliations
Review

Mid- to long-term complications and outcome for morbidly obese patients after total knee arthroplasty: a systematic review and meta-analysis

Joost van Tilburg et al. EFORT Open Rev. .

Abstract

Purpose: Due to substantial increase in obesity, the demand for total knee arthroplasty (TKA) in obese and morbidly obese patients is higher than ever. This review aims to investigate mid- to long-term complications, revision rates, and outcome for morbidly obese, compared with non-obese after TKA.

Methods: A systematic search was conducted in May 2021. Included studies reported revision rates for morbidly obese and non-obese with a mean follow-up of at least 2 years. Reported knee society score (KSS) has been used to compare the functional outcome. PRISMA protocol was followed, and PROSPERO registered (ID: CRD42021254119).

Results: From 12 studies that met the inclusion criteria, a total of 1031 cases of morbidly obese and 9797 cases of non-obese controls were included. The risk ratio for revision was 1.48 for the morbidly obese, compared with non-obese (95% CI: 0.98 to 2.24; P = 0.06). Regarding aseptic and septic revision, the risk ratio was 1.44 (95% CI: 0.64 to 3.25; P = 0.37) and 2.22 (95% CI: 0.89 to 5.57; P = 0.09), respectively. The morbidly obese scored lower in Objective Knee Society Score (OKSS) and Functional Knee Society Score (FKSS) both preoperatively and postoperatively, compared with the non-obese; however, the two groups improved equally in function scores OKSS (P= 0.967) and FKSS (P = 0.834). Overall risk ratio for complications was 1.56 (95% CI: 0.98 to 2.48; P = 0.06).

Conclusions: The gained benefit in functional outcome surpasses the increase in risk of revision and complications for the morbidly obese in TKA surgery.

Keywords: Knee Society Score; complication rate; functional outcome; morbidly obese; revision rate; total knee arthroplasty; total knee replacement.

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Figures

Figure 1
Figure 1
Flowchart of identification, screening, eligibility, and inclusion of studies.
Figure 2
Figure 2
Forest plot of risk ratios for revision among TKA performed in morbidly obese and non-obese patients. Events refer to the number of revisions for each group, and the total indicates the number of knees operated in each group. M–H, Mantel–Haenszel; df, degrees of freedom.
Figure 3
Figure 3
Forest plot of risk ratios for aseptic revision among TKA performed in morbidly obese and non-obese patients. Events refer to the number of aseptic revisions for each group, and total indicates the number of knees operated in each group. M–H, Mantel–Haenszel; df, degrees of freedom.
Figure 4
Figure 4
Forest plot of risk ratios for septic revision TKA performed in morbidly obese and non-obese patients. Events refer to the number of septic revisions for each group, and total indicates the number of knees operated in each group. M–H, Mantel–Haenszel; df, degrees of freedom.
Figure 5
Figure 5
Forest plot of risk ratio for overall complications in morbidly obese compared with non-obese patients. Events refer to the number of complications in each group, and total indicates the number of knees operated in each group. M–H, Mantel–Haenszel; df, degrees of freedom.
Figure 6
Figure 6
Forest plot of risk ratio for superficial wound infection in morbidly obese compared with non-obese patients. Events refer to the number of superficial wound infections in each group, and total indicates the number of knees operated in each group. M–H, Mantel–Haenszel; df, degrees of freedom.
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