Influence of body mass index (BMI) on functional improvements at 3 years following total knee replacement: a retrospective cohort study

Background The number of patients presenting for total knee replacement who are classified as obese is increasing. The functional benefits of performing TKR in these patients are unclear. Aim To assess the influence pre-operative body mass index has upon knee specific function, general health status and patient satisfaction at 3 years following total knee replacement. Design Retrospective comparative cohort study using prospectively collected data from an institutional arthroplasty register. Methods 1367 patients were assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Trust Short Form-36 (SF-36) scores supplemented by a validated measure of satisfaction pre-operatively and subsequently at 1,2 and 3 year post-operatively. Comparisons were made by dividing the cohort into 4 groups based on body mass index (BMI) 18.5–25.0 kg/m2 (n?=?253);>25.0–30.0 kg/m2 (n?=?559);>30.0?35.0 kg/m2 (n?=?373);>35.0 kg/m2 (n?=?182). Results Despite lower pre-operative, 1 and 3 year WOMAC and SF-36 scores patients with the highest BMIs >35.0 kg/m2 experienced similar improvements to patients with a ‘normal‘ BMI (18.5–25.0 kg/m2) at 1 year (Difference in WOMAC improvement?=?0.0 (95%CI ?5.2 to 5.2), p?=?1.00) and this improvement was sustained at up to 3 years (Difference in 1 year to 3 year improvement?=?2.2 (95%CI: ?2.1 to 6.5), p?=?1.00). This effect was also observed for the SF-36 mental and physical component scores. Despite equivalent functional improvements levels of satisfaction in the >35.0 kg/m2 group were lower than for any other BMI group (>35.0 kg/m2?=?84.6% satisfied versus 18.5–5.0 kg/m2?=?93.3% satisfied,p?=?0.01) as was the proportion of patients who stated they would have the operation again (>35.0 kg/m2?=?69.6% versus 18.5–25.0 kg/m2?=?82.2%,p?=?0.01). Conclusion Obese and morbidly obese patients gain as much functional benefit from total knee replacement as patients with lesser body mass indexes. This benefit is maintained for up to 3 years following surgery. However, these patients are less satisfied with their knee replacement and almost a third would not have the operation again

The Clinical Outcome Study for dysferlinopathy

Objective: To describe the baseline clinical and functional characteristics of an international cohort of 193 patients with dysferlinopathy. Methods: The Clinical Outcome Study for dysferlinopathy (COS) is an international multicenter study of this disease, evaluating patients with genetically confirmed dysferlinopathy over 3 years. We present a cross-sectional analysis of 193 patients derived from their baseline clinical and functional assessments. Results: There is a high degree of variability in disease onset, pattern of weakness, and rate of progression. No factor, such as mutation class, protein expression, or age at onset, accounted for this variability. Among patients with clinical diagnoses of Miyoshi myopathy or limb-girdle muscular dystrophy, clinical presentation and examination was not strikingly different. Respiratory impairment and cardiac dysfunction were observed in a minority of patients. A substantial delay in diagnosis was previously common but has been steadily reducing, suggesting increasing awareness of dysferlinopathies. Conclusions: These findings highlight crucial issues to be addressed for both optimizing clinical care and planning therapeutic trials in dysferlinopathy. This ongoing longitudinal study will provide an opportunity to further understand patterns and variability in disease progression and form the basis for trial design

The Clinical Outcome Study for dysferlinopathy: An international multicenter study

Objective: To describe the baseline clinical and functional characteristics of an international cohort of 193 patients with dysferlinopathy. Methods: The Clinical Outcome Study for dysferlinopathy (COS) is an international multicenter study of this disease, evaluating patients with genetically confirmed dysferlinopathy over 3 years. We present a cross-sectional analysis of 193 patients derived from their baseline clinical and functional assessments. Results: There is a high degree of variability in disease onset, pattern of weakness, and rate of progression. No factor, such as mutation class, protein expression, or age at onset, accounted for this variability. Among patients with clinical diagnoses of Miyoshi myopathy or limb-girdle muscular dystrophy, clinical presentation and examination was not strikingly different. Respiratory impairment and cardiac dysfunction were observed in a minority of patients. A substantial delay in diagnosis was previously common but has been steadily reducing, suggesting increasing awareness of dysferlinopathies. Conclusions: These findings highlight crucial issues to be addressed for both optimizing clinical care and planning therapeutic trials in dysferlinopathy. This ongoing longitudinal study will provide an opportunity to further understand patterns and variability in disease progression and form the basis for trial design

Mean SF-36 Mental Component Score for each of the 4 BMI groups.

<p>Mean SF-36 Mental Component Score for each of the 4 BMI groups.</p

1 and 3 year satisfaction with house/yard work (Housework) and recreational activities (Recreation).

<p>Key for BMI groups: 1 = Normal BMI, 2 = Overweight, 3 = Obese class I, 4 = Obese class II/III.</p

Patients demographics for the study cohort.

<p>Groups were compared using ANOVA for continuous variables (Age, Co-morbidity) and the Chi-Squared test for categorical variables (Gender).</p

1 and 3 year satisfaction with relief of pain (Pain) and overall satisfaction (Overall).

<p>Key for BMI groups: 1 = Normal BMI, 2 = Overweight, 3 = Obese class I, 4 = Obese class II/III.</p

Comparison of the WOMAC, SF-36 PCS and SF-36 MCS scores for the 4 BMI groups.

<p>p values (ANOVA) represents presence of a difference between any of the four groups.</p

Mean SF-36 Physical Component Score for each of the 4 BMI groups.

<p>Mean SF-36 Physical Component Score for each of the 4 BMI groups.</p