The effect of obesity on revision rate in unicompartmental knee arthroplasty: a systematic review and meta-analysis
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The effect of obesity on revision rate in unicompartmental knee arthroplasty: a systematic review and meta‑analysis Omar Musbahi1 · Thomas W. Hamilton1 · Adam J. Crellin2 · Stephen J. Mellon1 · Benjamin Kendrick1 · David W. Murray1 Received: 20 July 2020 / Accepted: 21 September 2020 © The Author(s) 2020
Abstract The number of patients with knee osteoarthritis, the proportion that is obese and the number undergoing unicompartmental knee arthroplasty (UKA) are all increasing. The primary aim of this systematic review was to determine the effects of obesity on outcomes in UKA. A systematic review was performed using PRISMA guidelines and the primary outcome was revision rate per 100 observed component years, with a BMI of ≥ 30 used to define obesity. The MINORS criteria and OCEBM criteria were used to assess risk of bias and level of evidence, respectively. 9 studies were included in the analysis. In total there were 4621 knees that underwent UKA. The mean age in included studies was reported to be 63 years (mean range 59.5–72 years old)) and range of follow up was 2–18 years. Four studies were OCEBM level 2b and the average MINORS score was 13. The mean revision rate in obese patients (BMI > 30) was 0.33% pa (95% CI − 3.16 to 2.5) higher than in non-obese patients, however this was not statistically significant (p = 0.82). This meta-analysis concludes that there is no significant difference in outcomes between obese and non-obese patients undergoing UKA. There is currently no evidence that obesity should be considered a definite contraindication to UKA. Further studies are needed to increase the numbers in meta-analysis to explore activity levels, surgeon’s operative data, implant design and perioperative complications and revision in more depth. Level of evidence Level III. Keywords Unicompartmental knee arthroplasty · Unicondylar knee arthroplasty · Obesity · Body mass index · Reoperation Abbreviations BMI Body Mass Index CI Confidence interval KSS Knee society score LoE Level of evidence MD Mean difference MINORS Methodological Index for non-randomised studies NJR National joint registry OA Osteoarthritis OCEBM Oxford Centre for Evidence-Based Medicine OKS Oxford Knee Score
* Omar Musbahi [email protected] 1
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
Medical Sciences Division, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
2
OR Odds ratio PRISMA Preferred reporting in systematic reviews and meta-analyses PROMs Patient reported outcome measures TKA Total knee arthroplasty UKA Unicompartmental knee arthroplasty UKR Unicompartmental knee replacement WHO World Health Organisation
Introduction The incidence and prevalence of obesity in the Western World is increasing [3]. According to the World Health Organisation (WHO), the prevalence of obesity has nearly doubled worldwide over the past three and half decades, particularly in developing countries [3].
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