Morbid obesity: A significant risk factor for failure of two-stage revision total knee arthroplasty for infection

Chad D. Watts, Eric R. Wagner, Matthew T. Houdek, Douglas R. Osmon, Arlen D. Hanssen, David G. Lewallen, Tad M. Mabry

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Abstract

Background: Obese patients have a higher risk of complications following primary total knee arthroplasty, including periprosthetic joint infection. However, there is a paucity of data concerning the efficacy of two-stage revision arthroplasty in obese patients.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Methods: We performed a two-to-one matched cohort study to compare the outcomes of thirty-seven morbidly obese patients (those with a body mass index of ≥40 kg/m2) who underwent two-stage revision total knee arthroplasty for periprosthetic joint infection following primary total knee arthroplasty with the outcomes of seventy-four non-obese patients (those with a body mass index of <30 kg/m<2<). Groups were matched by sex, age, and date of reimplantation. Outcomes included subsequent revision, reinfection, reoperation, and Knee Society pain and function scores. The minimum follow-up time was five years.

Results: Morbidly obese patients had a significantly increased risk for revision surgery (32% compared with 11%; p < 0.01), reinfection (22% compared with 4%; p < 0.01), and reoperation (51% compared with 16%; p < 0.01). Implant survival rates were 80% for the morbidly obese group and 97% for the non-obese group at five years and 55% for the morbidly obese group and 82% for the non-obese group at ten years. Knee Society pain scores improved significantly following surgery in both groups; the mean scores (and standard deviation) were 50 ± 5 points for the morbidly obese group and 55 ± 2 points for the non-obese group (p = 0.06) preoperatively, 74 ± 5 points for the morbidly obese group and 89 ± 2 points for the non-obese group (p < 0.0001) at two years, 72 ± 6 points for the morbidly obese group and 88 ± 3 points for the non-obese group (p < 0.0001) at five years, and 56 ± 9 points for the morbidly obese group and 84 ± 3 points for the non-obese group (p = 0.01) at ten years.

Conclusions: Morbid obesity significantly increased the risk of subsequent revision, reoperation, and reinfection following two-stage revision total knee arthroplasty for infection. In addition, these patients had worse pain relief and overall function at intermediate-term clinical follow-up. Although two-stage revision should remain a standard treatment for chronic periprosthetic joint infection in morbidly obese patients, increased failure rates and poorer outcomes should be anticipated.

Original languageEnglish (US)
Pages (from-to)e154(1)
JournalJournal of Bone and Joint Surgery - American Volume
Volume96
Issue number18
DOIs
StatePublished - Sep 17 2014

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ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Watts, C. D., Wagner, E. R., Houdek, M. T., Osmon, D. R., Hanssen, A. D., Lewallen, D. G., & Mabry, T. M. (2014). Morbid obesity: A significant risk factor for failure of two-stage revision total knee arthroplasty for infection. Journal of Bone and Joint Surgery - American Volume, 96(18), e154(1). https://doi.org/10.2106/JBJS.M.01289