few people in any group needed repeat surgery within 10 years (fewer than 1 in 20) the risk was raised in the obesity class I and II groups compared to normal weight, but it remained well within accepted levels.They compared people’s reports of their knee function and pain 6 months after surgery. They looked at the numbers who needed repeat surgery within 10 years, or died within 90 days. The researchers took into account people’s age, sex, health at time of surgery, and deprivation of the area they lived in. Using World Health Organisation (WHO) groupings, they classed people as underweight (BMI lower than 18.5 mg/m2), normal weight (18.5 to 25 kg/m2), overweight (25 to 30 kg/m2), obese class I (30 to 35 kg/m2), obese class II (35 to 40 kg/m2) or obese class III (over 40 mg/m2). The researchers looked at the records of 493,710 people who had total knee replacement surgery. This large study considered all 3 outcomes after total knee surgery in people with a range of BMIs. However, many of the previous studies have been small, and have looked at a single outcome (repeat surgery, for example, knee pain and function, or death rate). Decision-makers may be concerned that surgery is more risky for people with a high BMI, and less likely to be successful. Despite this, some areas have a local rule that prevents GPs from making these referrals. UK guidance states that GPs can refer people with osteoarthritis and a high BMI for joint replacement surgery. They may, for example, be more likely to need repeat surgery. Previous studies have suggested that those who are older, frail, have other long-term conditions or a very high BMI may have worse outcomes. However, some groups of people may benefit less than others from surgery. They are usually safe, cost-effective procedures. Total knee replacements can reduce pain and improve function. The numbers are likely to rise as the population ages. Almost 1 in 10 people in the UK will need this surgery in their lifetime. In a total knee replacement, both sides of the knee joint are replaced. The researchers recommend that risk assessments are not based solely on BMI.įurther information about knee replacements is available on the NHS website. The study found that, irrespective of BMI, people had good outcomes from knee replacement surgery. This large study explored the effect of high BMI on the likely benefits of total knee replacements, the chances of needing repeat surgery, or of dying. They may believe that people with a high BMI benefit less than others, or have more complications, from the surgery. However, in some areas, decision-makers block or delay these referrals. National guidelines state that GPs can refer people with osteoarthritis and a high BMI (meaning they are living with obesity or overweight) for surgery. The body mass index (BMI) uses someone’s height and weight to work out if their weight is healthy. GPs refer people to surgeons when their knee joint is so badly worn or damaged, it is painful even at rest. The usual reason for them is osteoarthritis (painful and stiff joints). In the UK, knee replacements are common orthopaedic (bone and joint) procedures. The study concluded that someone’s weight alone should not rule out a referral for knee replacement surgery. Deaths after surgery were rare in any group. Research found that few people in any weight category needed repeat surgery within 10 years. Knee replacements can reduce pain and improve function, regardless of people’s weight.
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