Advertisement

Is unicompartmental knee arthroplasty truly contraindicated in an obese patient? A meta-analysis

Published:November 03, 2022DOI:https://doi.org/10.1016/j.jos.2022.09.011

      Abstract

      Background

      Obesity has long been considered a relative contraindication to unicompartmental knee arthroplasty (UKA). However, with improved implants and techniques, the criteria for UKAs have been challenged. This paper aims to assess the impact of body mass index (BMI) on revision rates and functional outcomes in UKAs.

      Methods

      Databases of Pubmed, EMBASE, MEDLINE, CINHL and the Cochrane registries were systematically searched following the PROSPERO protocol. Studies comparing implant survival and functional outcome scores between obese and non-obese patients after a UKA were included.

      Results

      Twenty-five articles reported revision rates or functional outcomes in 42,434 UKA surgeries. There was a trend to higher revision rates in patients with BMI > 30 kg/m2 (odds ratio [OR] 0.91 [0.79–1.05]), BMI >35 kg/m2 (OR 0.70 [0.48, 1.01]) or BMI >40 kg/m2 (OR 0.66 [0.41, 1.07]), although the difference was not significant. There was a significant larger improvement in Oxford Knee Scores in obese patients after a UKA (OR 2.68 [1.79, 3.57], p < 0.00001), but no difference in Knee Society Scores or Visual Analogue Scale scores.

      Conclusion

      With no significant increase in revision rates after a UKA, a significantly greater improvement in Oxford Knee Scores and no differences Knee Society Scores or Visual Analogue Scales, obesity should no longer be viewed as a relative contraindication when performing unicompartmental knee replacements.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kurtz S.
        • Ong K.
        • Lau E.
        • Mowat F.
        • Halpern M.
        Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.
        J Bone Joint Surg Am. 2007 Apr; 89: 780-785
        • Berend K.R.
        • Lombardi A.
        Liberal indications for minimally invasive Oxford unicondylar arthroplasty provide rapid functional recovery and pain relief.
        Surg Technol Int. 2007; 16: 193-197
        • Insall J.
        • Aglietti P.
        A five to seven-year follow-up of unicondylar arthroplasty.
        J Bone Joint Surg. 1980 Dec; 62: 1329-1337
        • Kozinn S.
        • Scott R.
        Unicondylar knee arthroplasty.
        J Bone Joint Surg. 1989 Jan; 71: 145-150
        • Marmor L.
        Unicornpartmental knee arthroplasty.
        Clin Orthop Relat Res. 1988; : 14-20
        • Liddle A.
        • Judge A.
        • Pandit H.
        • Murray D.
        Adverse outcomes after total and unicompartmental knee replacement in 101 330 matched patients: a study of data from the National Joint Registry for England and Wales.
        Lancet. 2014 Oct; 384: 1437-1445
        • Siman H.
        • Kamath A.
        • Carrillo N.
        • Harmsen W.
        • Pagnano M.
        • Sierra R.
        Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 Years: comparable reoperation, revision, and complication rates.
        J Arthroplasty. 2017 Jun; 32: 1792-1797
        • Baker P.
        • Jameson S.
        • Deehan D.
        • Gregg P.
        • Porter M.
        • Tucker K.
        Mid-term equivalent survival of medial and lateral unicondylar knee replacement.
        J Bone Joint Surg Br. 2012 Dec; 94-B: 1641-1648
        • Van der List J.
        • Chawla H.
        • Zuiderbaan H.
        • Pearle A.
        The role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: a meta-analysis critique.
        J Arthroplasty. 2016 Nov; 31: 2617-2627
      1. PROSPERO – review registration and search 2019.
        ([cited 29 May 2019]. Available from:)
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        BMJ. 2009; 339 (b2535-b2535)
        • MEDLINE® and PubMed®
        The resources guide.
        (Available from:)
      2. Cochrane database of systematic reviews.
        (Available from:)
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials revisited.
        Contemp Clin Trials. 2015 Nov; 45: 139-145
        • Higgins J.
        • Thompson S.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002 Jun 15; 21: 1539-1558
        • Higgins J.P.T.
        • Deeks J.J.
        Measuring inconsistency in meta-analyses.
        Br Med J. 2003 Sep; 327: 557-560
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (MINORS): development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Guyatt G.
        • Oxman A.
        • Akl E.
        • Kunz R.
        • Vist G.
        • Brozek J.
        • et al.
        GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables.
        J Clin Epidemiol. 2011; 64: 383-394
        • Affatato S.
        • Caputo D.
        • Bordini B.
        Does the body mass index influence the long-term survival of unicompartmental knee prostheses? A retrospective multi-centre study.
        Int Orthop. 2019 Jun; 43: 1365-1370
        • Berend K.R.
        • Lombardi A.
        • Adams J.
        Obesity, young age, patellofemoral disease, and anterior knee pain: identifying the unicondylar arthroplasty patient in the United States.
        Orthopedics. 2007 May; 30: 19-23
        • Bonutti P.M.
        • Goddard M.
        • Zywiel M.
        • Khanuja H.
        • Johnson A.
        • Mont M.
        Outcomes of unicompartmental knee arthroplasty stratified by body mass index.
        J Arthroplasty. 2011 Dec; 26: 1149-1153
        • Cavaignac E.
        • Lafontan V.
        • Reina N.
        • Pailhé R.
        • Warmy M.
        • Laffosse J.
        • et al.
        Obesity has no adverse effect on the outcome of unicompartmental knee replacement at a minimum follow-up of seven years.
        Bone Joint Lett J. 2013 Aug; 95-B: 1064-1068
        • Kandil A.
        • Werner B.
        • Gwathmey W.
        • Browne J.
        Obesity, morbid obesity and their related medical comorbidities are associated with increased complications and revision rates after unicompartmental knee arthroplasty.
        J Arthroplasty. 2015 May; 30: 456-460
        • Molloy J.
        • Kennedy J.
        • Jenkins C.
        • Mellon S.
        • Dodd C.
        • Murray D.
        Obesity should not be considered a contraindication to medial Oxford UKA: long-term patient-reported outcomes and implant survival in 1000 knees.
        Knee Surg Sports Traumatol Arthrosc. 2019 Jul; 27: 2259-2265
        • Murray D.W.
        • Pandit H.
        • Weston-Simons J.
        • Jenkins C.
        • Gill H.
        • Lombardi A.
        • et al.
        Does body mass index affect the outcome of unicompartmental knee replacement?.
        Knee. 2013 Apr; 20: 461-465
        • Naal F.D.
        • Neuerburg C.
        • Salzmann G.
        • Kriner M.
        • von Knoch F.
        • Preiss S.
        • et al.
        Association of body mass index and clinical outcome 2 years after unicompartmental knee arthroplasty.
        Arch Bone Jt Surg. 2008 Apr; 129: 463-468
        • Nettrour J.F.
        • Ellis R.
        • Hansen B.
        • Keeney J.
        High failure rates for unicompartmental knee arthroplasty in morbidly obese patients: a two-year minimum follow-up study.
        J Arthroplasty. 2020 Apr; 35: 989-996
        • Plate J.F.
        • Augart M.
        • Seyler T.
        • Bracey D.
        • Hoggard A.
        • Akbar M.
        • et al.
        Obesity has no effect on outcomes following unicompartmental knee arthroplasty.
        Knee Surg Sports Traumatol Arthrosc. 2017 Mar; 25: 645-651
        • Polat A.E.
        • Polat B.
        • Gürpinar T.
        • Peker B.
        • Tüzüner T.
        Factors affecting the functional outcome of Oxford phase 3 unicompartmental knee arthroplasty.
        Acta Ortopédica Bras. 2020 Mar-Apr; 28: 78-83
        • Polat A.E.
        • Polat B.
        • Gürpınar T.
        • Çarkçı E.
        • Güler O.
        The effect of morbid obesity (BMI ≥ 35 kg/m2) on functional outcome and complication rate following unicompartmental knee arthroplasty: a case-control study.
        J Orthop Surg Res. 2019 Aug 22; 14: 266
        • Scott C.E.H.
        • Wade F.
        • MacDonald D.
        • Nutton R.
        Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component.
        Arch Orthop Trauma Surg. 2018; 138: 719-729
        • Sébilo A.
        • Casin C.
        • Lebel B.
        • Rouvillain J.
        • Chapuis S.
        • Bonnevialle P.
        Clinical and technical factors influencing outcomes of unicompartmental knee arthroplasty: Retrospective multicentre study of 944 knees.
        Orthop Traumatol Surg Res. 2013; 99: S227-S234
        • Seth A.
        • Dobransky J.
        • Albishi W.
        • Dervin G.
        Mid-term evaluation of the unicompartmental knee arthroplasty in patients with BMI of 40 or greater.
        J Knee Surg. 2019; 34: 427-433
        • Sohár G.
        • Mécs L.
        • Greksa F.
        • Tóth K.
        Early results of minimally invasive medial unicompartmental knee arthroplasty associated with obesity.
        Osteoarthritis Cartilage. 2012; 20: S296
        • Stefano B.
        • Khatod M.
        • Cafri G.
        • Chen Y.
        • Paxton E.
        Surgeon, implant, and patient variables may explain variability in early revision rates reported for unicompartmental arthroplasty.
        J Bone Joint Surg. 2013; 95: 2195-2202
        • Sundaram K.
        • Warren J.
        • Anis H.
        • George J.
        • Murray T.
        • Higuera C.
        • et al.
        An increased body mass index was not associated with higher rates of 30-day postoperative complications after unicompartmental knee arthroplasty.
        Knee. 2019; 26: 720-728
        • Tabor O.B.
        • Tabor O.B.
        • Bernard M.
        • Wan J.Y.
        Unicompartmental knee arthroplasty: long-term success in middle-age and obese patients.
        J Surg Orthop Adv. 2005; 14: 59
        • Seyler T.
        • Mont M.
        • Lai L.
        • Xie J.
        • Marker D.
        • Zywiel M.
        • et al.
        Mid-term results and factors affecting outcome of a metal-backed unicompartmental knee design: a case series.
        J Orthop Surg Res. 2009; 4: 39
        • Venkatesh H.
        • Maheswaran S.
        Age and body mass index has no adverse effect on clinical outcome of unicompartmental knee replacement - Midterm followup study.
        Indian J Orthop. 2019; 53: 442-445
        • Woo Y.L.
        • Chen Y.
        • Lai M.
        • Tay K.
        • Chia S.
        • Lo N.
        • et al.
        Does obesity influence early outcome of fixed-bearing unicompartmental knee arthroplasty?.
        J Orthop Surg. 2017; 25: 1-5
        • Xing Z.
        • Katz J.
        • Jiranek W.
        Unicompartmental knee arthroplasty: factors influencing the outcome.
        J Knee Surg. 2012; 25: 369-374
        • Xu S.
        • Lim W.
        • Chen J.
        • Lo N.
        • Chia S.
        • Tay D.
        • et al.
        The influence of obesity on clinical outcomes of fixed-bearing unicompartmental knee arthroplasty.
        Bone Joint J. 2019; 101-B: 213-220
        • Zengerink I.
        • Duivenvoorden T.
        • Niesten D.
        • Verburg H.
        • Bloem R.
        • Mathijssen N.
        Obesity does not influence the outcome after unicompartmental knee arthroplasty.
        Acta Orthop Belgica. 2015; 81: 776-783
        • Hurst J.
        • Berend K..
        Mobile-bearing Unicondylar Knee Arthroplasty.
        Orthop Clin North Am. 2015; 46: 113-124
        • Goodfellow J.
        • O’Connor J.
        • Dodd C.
        • Murray D.
        Unicompartmental arthroplasty with the Oxford Knee. The Oxford University Press, Oxford (United Kingdom)2006: 1-67