Post-operative Weight Gain After Total Knee Arthroplasty: Prevalence and Its Possible Attenuation Using Intraoperative Sensors
As the proportion of adults with obesity continues to climb, so too does the need for total knee arthroplasty. Unfortunately, total knee replacement patients often experience post-operative weight gain, despite improved joint function. The purposes of this study were: 1) To execute a literature meta-analysis in order quantify the changes in body mass that are typically observed following TKA, and 2) Evaluate data from a prospective, multicenter study to assess any trends towards weight loss in a group of “balanced”, sensor-assisted TKA patients. The literature review found that average proportion of patients who had weight gain after TKA is 47% to 66%. In literature, the average post-operative weight gain was 9.5 lbs. (1.6 kg/m2 BMI increase), up to 14 lbs. (2.3 kg/m2). In the multicenter study, only 30.4% of patients and 36.9% of patients exhibited weight gain at 6 months and 1 year, respectively. At the 1-year interval, this indicates an 11% decrease from reported averages (p=0.049), up to 29% as reported by the NIH (p<0.001). The average weight gain in the multicenter patient group was 4.3 lbs. (0.72 kg/m2 BMI increase) at 6 months, and 3.5 lbs. (0.58 kg/m2) at 1 year, both of which are non-clinically meaningful. The average weight loss of those in the non-gaining group was 7.8 lbs. (1.3 kg/m2) at 6 months and 9.6 lbs. (1.6 kg/m2) at 1 year. Both of these values are clinically meaningful. This evaluation demonstrates that weight gain after TKA is prevalent, but ensuring soft-tissue balance (via technologies such as intraoperative sensing) may help mitigate this expected increase in body mass.
Keywords: total knee arthroplasty, increased BMI, intraoperative sensors, weight gain, obesity
National Institutes of Health. Clinical guidelines on the identification, evaluation, and Treatment of overweight and obesity in adults—The evidence report. Obes Res 6(Suppl 2):51S–209S. 1998.
National Institute for Health and Clinical Excellence. National Collaborating Centre for Chronic Conditions Osteoarthritis: national clinical guideline for care and management in adults. London, UK: NICE; 2008.
McLellan F. Obesity rising to alarming levels around the world. Lancet.2002 Apr 20;359(9315):1412.
Ogden CL, Carroll MD, Kit BK, et al. Prevalence of Obesity in the United States, 2009–2010. NCHS Data Brief U.S. Dept Health and Hum Serv. 2012; (42): 1-7
Finkelstein EA, Trogdon JG, Cohen JW, et al. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs. 2009;28(5):822-831
Nicholls AS, Kiran A, Javaid MK, et al. Change in body mass index during middle age affects risk of total knee arthoplasty due to osteoarthritis: a 19-year prospective study of 1003 women. Knee. 2012 Aug;19(4):316-319.
Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. International Journal of Obesity (2008) 32, 1431–1437
Institute of Medicine, National Academy of Sciences. Weighing the Options: Criteria for Evaluating Weight Management Programs. Government Printing Office: Washington, DC, 1995.
P. Kopelman. Health risks associated with overweight and obesity. Obesity Reviews. 2007; 8(1):13–17.
Donovan J, Dingwall I, McChesney S. Weight change 1 year following total knee or hip arthroplasty. ANZ J Surg. 2006; 76(4): 222-225.
Zeni JA, Snyder-Mackler L. Most patients gain weight in the 2 years after total knee arthroplasty: comparison to a healthy control group. (NIH Public Access Manuscript) Osteoarthritis Cartilage. 2010; 18(4): 510-514.
Riddle DL, Singh JA, Harmsen WS, et al. Clinically important body weight gain following knee arthroplasty: a five-year comparative cohort study. Arthritis Care Res (Hoboken). 2013; 65(5): 669-677.
Abu-Rajab RB, Findlay H, Young D, et al. Weight changes following lower limb arthroplasty: a prospective observational study. Scott Med J. 2009; 54(1): 26-28.
Heisel C, Silva M, dela Rosa MA, et al. The effects of lower-extremity total joint replacenet for arthritis on obesity. Orthopedics. 2005; 28(2): 157-159.
Gustke KA, Golloday GJ, Roche MW, et al. A new method for defining balance: promising short-term clinical outcomes of sensor-guided TKA. J Arthroplasty. 2013; doi:pii: S0883-5403(13)00802-4.10.1016/j.arth.2013.10.020 [E-pub ahead of print].
How to Cite
Copyright (c) 2014 Gregory Golladay MD, Gerald Jerry MD, Kenneth Gustke MD, Martin Roche MD, Leah Elson BSc, Christopher Anderson MSc
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.