Abstract
Introduction
Rapid recovery protocols after joint replacement have been implemented widely to decrease hospital length of stay (LOS). Minimally-invasive total knee arthroplasty (MIS-TKA) may facilitate rapid recovery for patients. Increased complications and LOS have been documented in morbidly obese TKA patients. The objective of the current study was to retrospectively evaluate the impact of morbid obesity on MIS-TKA patients.
Methods
We conducted a retrospective chart review on patients that underwent MISTKA at a high volume orthopedic center between August 2012 and September 2015 (N = 4173). All surgeries were performed by one of six fellowship trained surgeons utilizing the same implant. MISTKA was performed utilizing a mid-vastus approach under tourniquet. All patients experienced rapid recovery protocols utilizing multi-modal pain management pathways, same day physical therapy, and absence of CPM machines. We evaluated patient age, gender, operative time, LOS, and 90-day readmission for morbidly obese (BMI≥40; n = 597), and non-morbidly obese (BMI<40; n = 3576) patients. Statistical analysis was conducted using Minitab 16 Statistical Software.
Results
Morbidly obese patients had significantly higher mean LOS (1.74 days) compared to non-morbidly obese patients (1.62 days, p=0.035), and significantly higher 90-day readmissions (12.45% and 6.65% respectively, p= 0.001). In patients over the age of 65, with BMI under 40, females had significantly higher mean LOS than males (1.70 and 1.47 days respectively, p< 0.001). And in non-morbidly obese patients under the age of 65, females still experienced significantly higher mean LOS compared to males (1.35 and 1.11 days respectively, p<0.001)
Conclusions
Our findings indicate that despite implementation of rapid recovery protocols, morbidly obese patients experienced significantly higher LOS than non-morbidly obese patients. Compared to their male counterparts, non-morbidly obese female patients had significantly higher LOS.
