This study was funded by the Norwegian Research Council of Norway and the South-Eastern Regional Health Authority. Olsen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Patients with higher BMI prior to total knee arthroplasty typically experience worse overall physical function following surgery, while those with lower osteoarthritis severity experience more positive outcomes, according to data.
“More than one in five patients do not regain physical function after TKA,” Unni Olsen, RN, MSc, of the department of orthopedic surgery at the University of Oslo, in Norway, and co-authors wrote in JAMA Network Open. “Non-improvement of physical function is a risk factor associated with more expensive revision surgery and an immense burden at individual, health care system and socioeconomic levels.”
To investigate the impact of preoperative factors on physical function following a total knee arthroplasty, Olsen and colleagues conducted a systematic review and meta-analysis of studies published between Jan. 1, 2000, and Oct. 8, 2021. The search included Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library and Physiotherapy Evidence Database, the authors wrote. Eligible studies examined the association between preoperative or intraoperative factors on physical function, as well as physical function performance numbers at 3, 6 or 12 months following the procedure.
Studies were additionally eligible if they enrolled adults diagnosed with OA who were scheduled for a primary TKA and featured prospective, longitudinal observational analyses. Randomized clinical trials providing appropriate information were also included. The authors excluded retrospective studies, case reports and conference abstracts.
The primary outcome was physical function at 12 months following surgery, while the secondary outcomes were physical function at 3 and 6 months following surgery. Data of interest included study design, sample size, patient age, BMI and sex, the country the study was performed in, outcome measures, data collection timepoints and estimates of association between factors and physical function.
In all, the review included 20 studies representing 11,317 patients and 37 distinct factors. In terms of relationships with postoperative function, higher BMI had an estimated mean correlation of –0.15 (95% CI, –0.24 to –.05), while the mean correlation with better physical function was 0.14 (95% CI, 0.02-0.26). Severe OA demonstrated a mean correlation of 0.1 (95% CI, 0.01-0.19).
“This study found that there is evidence (with moderate certainty) that higher BMI was correlated with worse physical function and that better physical function (low-certainty evidence) and more severe osteoarthritis (high-certainty evidence) were correlated with better physical function 12 months after TKA,” Olsen and colleagues wrote. “Our findings suggest that these factors should be included in development of predictive models aimed at identifying patients at increased risk of poor function after TKA.”
- Maradit KH, et al. J Arthroplasty. 2017;doi: 10.1016/j.arth.2017.05.043.
- Weber M, et al. Biomed Res Int. 2018;doi: 10.1155/2018/8987104.
- Wieczorek M, et al. Arthritis Care Res. 2020;doi: 10.1002/acr.24045.