Obesity Severity Does Not Associate with Rate, Timing, or Invasiveness of Early Reinterventions After Total Knee Arthroplasty.

Overview

abstract

INTRODUCTION: The use of body mass index (BMI) cut-off values has been suggested for proceeding with total knee arthroplasty (TKA) in obese patients. However, the relationship between obesity severity and early reoperations after TKA is poorly defined. This study evaluated whether increased World Health Organization (WHO) Obesity Class was associated with risk, severity, and timing of reintervention within one year after TKA. METHODS: There were 8,674 patients from our institution who had a BMI ≥ 30 and underwent unilateral TKA for primary osteoarthritis between 2016 to 2021. Patients were grouped by WHO Obesity Class: 4,456 Class I (51.5%), 2,527 Class II (29.2%), and 1,677 Class III (19.4%). A chart review was performed to determine patient characteristics and identify patients who underwent any closed or open reintervention requiring anesthesia within the first postoperative year. Regression analyses were performed to identify variables associated with increased odds ratios (ORs) for requiring a reintervention, its timing, and invasiveness. RESULTS: There were 158 patients (1.8%) who required at least one reintervention, and 15 patients (0.2%) required at least two reinterventions. Reintervention rates for Obesity Class I, II, and III were 1.8% (n = 81), 2.0% (n = 51), and 1.4% (n = 23), respectively. There were 65 closed procedures (41.1%), 47 minor procedures (29.7%), 34 open with or without liner exchange (21.5%), and 12 revisions with component exchange (7.6%). Obesity Class was not associated with reintervention rate (P = 0.3), timing (P = 0.36), or invasiveness (P = 0.93). Diabetes (OR = 2.47; P = 0.008) was associated with a need for reintervention. Non-Caucasian race (OR = 1.7; P = 0.01) and Charlson Comorbidity Index (OR = 2.1; P = 0.008) were associated with earlier reintervention. No factors were associated with the invasiveness of reintervention. CONCLUSION: The WHO Obesity Class did not associate with rate, timing, or invasiveness of reintervention after TKA in obese patients. These findings suggest that policies that restrict the indication for elective TKA based only on a BMI limit have limited efficacy in reducing early reintervention after TKA in obese patients.