Revision Rates and Functional Outcomes Among Severely, Morbidly, and Super-Obese Patients Following Primary Total Knee Arthroplasty
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
BACKGROUND: Obesity has been associated with a greater burden of symptomatic knee osteoarthritis. There is some evidence that patients with a very high body mass index (BMI) may have a higher risk of complications and poor outcomes following total knee replacement compared with non-obese patients or obese patients with a lower BMI. We hypothesized that increasing degrees of obesity would be associated with deteriorating outcomes for patients following total knee replacement. METHODS: We performed a comprehensive systematic review of 4 medical databases (MEDLINE, AMED, Ovid Healthstar, and Embase) from inception to August 2016. We extracted data to determine revision risk (all-cause, septic, and aseptic) and functional outcome scores (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Knee Society Score, Oxford Knee Score, EuroQol-5D, and Short Form [SF]-12 Physical Component Summary) in patients with severe obesity (BMI ≥35 kg/m), morbid obesity (BMI ≥40 kg/m), and super-obesity (BMI ≥50 kg/m) in comparison with patients with a normal BMI (<25 kg/m). Meta-analysis was performed using a random effects model. RESULTS: We screened 3,142 titles and abstracts and 454 full-text articles to identify 40 eligible studies, of which 37 were included in the meta-analysis. Compared with patients with a normal BMI, the risk ratio for an all-cause revision surgical procedure was 1.19 (95% confidence interval [CI], 1.03 to 1.37; p = 0.02) in patients with severe obesity, 1.93 (95% CI, 1.27 to 2.95; p < 0.001) in patients with morbid obesity, and 4.75 (95% CI, 2.12 to 10.66; p < 0.001) in patients with super-obesity. The risk ratio for septic revision was 1.49 (95% CI, 1.28 to 1.72; p < 0.001) in patients with severe obesity, 3.69 (95% CI, 1.90 to 7.17; p < 0.001) in patients with morbid obesity, and 4.58 (95% CI, 1.11 to 18.91; p = 0.04) in patients with super-obesity. There were no significant differences (p > 0.05) in risk of aseptic revision. Based on the Knee Society Scores reported in a single study, patients with super-obesity had outcome scores, expressed as the standardized mean difference, that were 0.52 lower (95% CI, 0.80 lower to 0.24 lower; p < 0.001) than non-obese controls; however, no difference was observed for severe or morbidly obese patients. CONCLUSIONS: The risk of septic revision is greater in patients with severe obesity, morbid obesity, and super-obesity, with progressively higher BMI categories associated with a higher risk. However, the risk of aseptic revision was similar between all obese and non-obese patients. Functional outcome improvements are also similar, except for super-obese patients, in whom data from a single study suggested slightly lower scores. These findings may serve to better inform evidence-based clinical, research, and policy decision-making. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it