Research Article
Volume 11 Issue 10 - 2020
Bariatric Orthopaedics: Impact of Obesity on Total Knee Replacement
Butt A J, Zain-ur-Rehman M*, Tarek A, Ditta A N and Amjad A
Department of Orthopedic Surgery, King Hamad University Hospital, Kingdom of Bahrain
*Corresponding Author: Muhammad Zain-ur-Rehman, Registrar Orthopedic Surgery, Department of Orthopedic Surgery, King Hamad University Hospital, Kingdom of Bahrain.
Received: August 09, 2020; Published: September 29, 2020


Introduction: Total knee replacement is a reliable operation for reducing pain and improving function in severe osteoarthritis of the knee. As incidence of obesity is increasing worldwide, there is a debate about the role of Body Mass Index (BMI) in selection of patients requiring total knee replacement. The aim of the study was to evaluate the impact of body mass index on total knee replacement in terms of post-operative improvement in knee range of motion, patient satisfaction and complications.

Materials and Methods: Out of 175 patients who suffered from advance knee osteoarthritis and were candidates for primary total knee replacement from January 2016 to March 2018, 155 patients fit the inclusion criteria. Group 1 included 66 patients who were overweight and class 1 obese while group 2 included 89 patients who were class 2 and 3 obese according to WHO Body Mass Index classification. All patients underwent total knee replacement according to the hospital guidelines. Pre and post-operative range of motion, patient satisfaction and complications were assessed and documented.

Results: There was no statistically significant difference in improvements in post-operative knee range of motion between the two groups up to 2 years of follow up [Mann-Whitney U test p = 0.069]. Similarly, Mann-Whitney U test showed that there is no significant difference between patient satisfaction levels (SF-12 scores) of the two groups (p = 0.09).

Conclusion: There is no significant impact of obesity on outcomes after total knee replacement and BMI should not be used as a factor in selecting patients who qualify for total knee replacement.

Level of Evidence: Level III.

Keywords: Total Knee Replacement; Obesity; Body Mass Index (BMI); Bariatric Orthopedics


  1. Alska E., et al. “Obesity among elderly people measures, causes. Nutrition guidelines for the elderly”. Journal of Health Sciences 16 (2014): 144-154.
  2. Asokan G., et al. “Osteoarthritis Among Women in Bahrain: A Public Health Audit”. Oman Medical Journal 6 (2011): 426-430.
  3. Ast MP., et al. “Weight changes after total hip or knee arthroplasty: prevalence, predictors, and effects on outcomes”. The Journal of Bone and Joint Surgery American 97 (2015): 911.
  4. Baker P., et al. “The association between body mass index and the outcomes of total knee arthroplasty”. The Journal of Bone and Joint Surgery American 16 (2012): 1501-1508.
  5. Baker P., et al. “Influence of body mass index (BMI) on functional improvements at 3 years following total knee replacement: a retrospective cohort study”. PLoS One3 (2013): e59079.
  6. Conner-Spady BL., et al. “Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement”. Quality of Life Research 24 (2015): 1775.
  7. Cushnaghan J., et al. “Long-term outcome following total knee arthroplasty: a controlled longitudinal study”. Annals of the Rheumatic Diseases 5 (2009): 642-647.
  8. Dowsey MM., et al. “The impact of preoperative obesity on weight change and outcome in total knee replacement: a prospective study of 529 consecutive patients”. The Journal of Bone and Joint Surgery British 92 (2010): 513-520.
  9. George J., et al. “Obesity Epidemic: Is Its Impact on Total Joint Arthroplasty Underestimated? An Analysis of National”. Trends Clinical Orthopaedics and Related Research 475 (2017): 1798-1806.
  10. Gillespie GN and Porteous AJ. “Obesity and knee arthroplasty”. Knee 14 (2007): 81-86.
  11. Hamid R., et al. “Obesity Does Not Imply Poor Outcomes in Asians after Total Knee Arthroplasty”. Clinical Orthopaedics and Related Research 471 (2013): 1957-1963.
  12. Ja¨rvenpa¨a¨ J., et al. “Obesity may impair the early outcome of total knee arthroplasty”. Scandinavian Journal of Surgery 99 (2010): 45-49.
  13. Kellgren JH and lawrence JS. “Radiological assessment of osteo-arthrosis”. Annals of the Rheumatic Diseases 4 (1957): 494-502.
  14. Lachiewicz AM and Lachiewicz PF. “Weight and activity change in overweight and obese patients after primary total knee arthroplasty”. The Journal of Arthroplasty 23 (2008): 33-40.
  15. Lui M., et al. “Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review”. Systematic Reviews 4 (2015): 121-129.
  16. Mark D Kohn., et al. “Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis”. Orthopedics and Related Research8 (2016): 188.
  17. Matla J., et al. “Assessment of the impact of body fatness on functional performance in early stages of rehabilitation after knee replacement” (2017).
  18. Naylor JM., et al. “Severe other joint disease and obesity independently influence recover after joint replacement surgery: an observational study”. International Journal of Obesity 54 (2008): 57-64.
  19. Oberbek J and Synder M. “Impact of Body Mass Index (BMI) on early outcomes of total knee arthroplasty”. Ortopedia Traumatologia Rehabilitacja6 (2015): 127-134.
  20. Perry C., et al. “The use of a dietary quality score as a predictor of childhood overweight and obesity”. BMC Public Health 24 (2015): 581-590.
  21. Ramachandran A and Snehalatha C. “Rising burden of obesity in Asia”. Journal of Obesity (2010): 868573.
  22. Stevens-Lapsley JE., et al. “Impact of body mass index on functional performance after total knee arthroplasty”. The Journal of Arthroplasty7 (2010): 1104-1109.
  23. World Health Organization. “Obesity and overweight. Statistics” (2016).
Citation: Zain-ur-Rehman M., et al. “Bariatric Orthopaedics: Impact of Obesity on Total Knee Replacement”.EC Dental Science 19.10 (2020): 32-38.

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