Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review.

Michelle Lui,Marie D Westby,C Allyson Jones

doi:10.1186/s13643-015-0107-2

Abstract

BackgroundOf the more than 104,000 Canadians who underwent elective total joint arthroplasty (TJA) surgery in 2012–2013 for hip and knee osteoarthritis (OA), 40 and 60 %, respectively, were obese. Obesity is associated with increased risks for receiving TJA, post-operative complications and delayed functional recovery. Current guidelines for patients with a body mass index (BMI) of ≥30 kg/m2 are to participate in a weight management programme and to lose weight prior to TJA surgery. As part of a larger project, a rapid review was conducted to examine the effects of short-term non-pharmacological and non-surgical weight loss interventions in adults in the year prior to total hip arthroplasty (THA) and total knee arthroplasty (TKA) on surgical and patient outcomes, and adverse events.MethodsWe performed a rapid review and searched seven electronic databases for English language articles published between 1990 and February 2015. Observational studies evaluating the association between pre-operative weight loss and short- and long-term outcomes, and controlled trials of non-pharmacological and non-surgical weight loss interventions were considered for inclusion. Two reviewers independently screened and selected articles, assessed methodological quality and extracted data.ResultsOf 263 articles identified, a total of four studies met our inclusion criteria. In one of two high-quality retrospective cohort studies, weight loss ≥5 % of body weight in the year prior to TJA and maintained in the year after surgery was associated with a higher likelihood of deep surgical site infection in THA patients and 90-day readmission in TKA patients. No significant differences were reported in incidence of superficial surgical site infections in THA or TKA patients who lost weight pre-operatively compared to those who maintained their weight in either study. Two abstracts of randomized controlled trials were included; however, despite contacting the authors, full-length articles were not available. The limited information from the trials suggested that short-term dietician-supervised weight loss interventions were effective in weight loss prior to TJA.ConclusionsThere is limited evidence to support the recommendation of weight loss in the year prior to TJA and to determine the effectiveness of short-term non-pharmacological, non-surgical weight management interventions on patient and surgical outcomes.

Highlights

Of the more than 104,000 Canadians who underwent elective total joint arthroplasty (TJA) surgery in 2012–2013 for hip and knee osteoarthritis (OA), 40 and 60 %, respectively, were obese
Of the more than 104,000 TJA procedures performed in Canada in 2012–2013, 40 % of total hip arthroplasty (THA) and 60 % of total knee arthroplasty (TKA) patients were obese [8]
Candidates for TJA who are obese are often advised to lose weight prior to surgery as obesity is associated with increased peri- and post-operative complications [9] and slower functional improvement post-operatively [10,11,12,13]

Summary

Introduction

Of the more than 104,000 Canadians who underwent elective total joint arthroplasty (TJA) surgery in 2012–2013 for hip and knee osteoarthritis (OA), 40 and 60 %, respectively, were obese. Obesity is associated with increased risks for receiving TJA, post-operative complications and delayed functional recovery. Current guidelines for patients with a body mass index (BMI) of ≥30 kg/m2 are to participate in a weight management programme and to lose weight prior to TJA surgery. Obesity, defined as having a body mass index (BMI) of ≥30 kg/m2 [1], is strongly associated with the development of osteoarthritis (OA) of the knee [2, 3] and to a lesser extent of the hip joint [4]. The current recommendations based on international guidelines are to acknowledge and mitigate the risks associated with obesity in patients undergoing TJA surgery [16, 17]. The most recent of the two guidelines included papers published before April 2011, and more recent evidence may provide further guidance on this topic

Methods

Results

Discussion

Conclusion