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Study overturns common assumption about knee replacements in morbidly obese individuals
Date:11/10/2012

y identified all patients with a BMI greater than 18.5 who had undergone a TKR between July 2007 and June 2009. Patient pain and function had been assessed prior to surgery and two years after surgery using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The WOMAC measures pain, stiffness, and functional limitation. It is one of the more widely used tools for measuring outcomes after TKR.

The investigators found that two years after surgery, pain and function scores improved across all BMI categories and as BMI rose, patient improvements increased. Patients with a BMI greater than 40 showed the most improvement.

"The morbidly obese did well in terms of their pain and function outcomes. They start out in a much worse situation and then by two years, they are pretty much caught up," said Dr. Goodman. "I was surprised, because my expectation was that they wouldn't do as well, their functional outcomes wouldn't be as good, and they wouldn't be as satisfied. But, it turns out that they were really quite satisfied."

Dr. Goodman said that many surgeons have concerns about performing knee replacements in the morbidly obese. Almost 90% of referring physicians believe that obesity increases the likelihood of poor outcomes after a TKR.

"There is no question that the morbidly obese are a more difficult group to managethey are more likely to have a significant number of comorbidities, including cardiac disease," said Dr. Goodman. "If you look at the Deyo comorbidity scale of the patients in our study, the morbidly obese had a significantly greater number of comorbidities than normal, so they were definitely sicker to start with, but their outcomes were just as good."

In a multivariate analysis, the researchers identified a number of other factors that correlated with pain outcomes after surgery. They found that individuals who were Caucasian experienced less pain, and individuals who were female or had only a high school education ha
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Contact: Phyllis Fisher
phylils.fisher@gmail.com
212-606-1724
Hospital for Special Surgery
Source:Eurekalert

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