Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_17_библиотеки_им_акад_М_И_Перельмана
.pdf
Lifestyle andRisk Factors forKnee Arthroplasty: ASouth African Perspective
https://t.me/medicina_free
93
9
. Table 9.1 Summary of parameters dening malnutrition
(World Health Organisation (WHO) 2018; Springer etal.
2017)
Undernutrition Overnutrition
Serum marker
Albumin (g/dL) <3.5 Over-
Total lymphocyte
count (cells/mm
Transferrin (μg/dL)
Anthropometry Measure-
BMI (kg/m
BMI Body Mass Index
3
)
2
) <18.5
Measurement
<1500 Obesity 30–39.9
<200 Morbid
ment
Classication
weight
obesity
Super
obesity
BMI (kg/
2
m
)
25–29.9
40–49.9
>50
tion. However, triceps skinfold and arm muscle circumference have been found to correlate with serum
albumin.
> The use of either low serum albumin or low serum
transferrin increases the sensitivity and specicity of
dening malnutrition, especially as both have been
shown to directly predict increased complications
(Carli et al. 2019; Huang et al. 2013; Tobert et al.
2018).
edema and suboptimal oxygen tension compromise tissue tensile strength and contribute to poor healing with
postoperative wound problems and potential wound
dehiscence (Blevins etal.
2018; Carli etal. 2019; Greene
etal. 1991; Ryan etal. 2018; Tsantes etal. 2019).
PJI is the most common reason for revision in
patients undergoing TKA with undernutrition.
> The risk of supercial skin infections (SSI) is
2–3 times higher in undernourished patients, while
the likelihood of deep PJI rises by 2.3–3.6 times,
respectively.
The likelihood of an early revision within 30days of primary TKA as a result of SSI is tenfold higher in undernourished patients (Carli etal. 2019; Huang etal. 2013;
Schroer etal. 2018). In comparison with other modiable
risk factors including anemia, uncontrolled diabetes, narcotic and tobacco use, Schroer etal. (2018) showed that
undernutrition was associated with the highest rate of
90-day readmissions (Schroer etal. 2018). In addition to
PJI, undernutrition is an independent risk factor for
renal and neurovascular adverse events and hematoma
or seroma formation. Bala etal. (2020) reported signicantly more major complications in protein- malnourished
patients when compared with a control cohort undergoing TJA (Bala etal. 2020). The increase in postoperative
complications included more pulmonary embolisms,
acute myocardial infarctions, occlusive strokes, and
respiratory and heart failures (Courtney etal. 2016).
Markers of nutritional status include blood sample
measurements of the following:
5 Zinc
5 Vitamin D
5 Transferrin
5 Albumin
5 Total lymphocyte count
Low preoperative serum albumin is the most accurate
predictor of postoperative infective complications.
> Greene etal. (2020) reported that a serum albumin of
<3.5g/dL or a total lymphocyte count of <1500 cells/
3
mm
inferred a seven- and vefold increased risk of
major wound complications after TJA (Greene etal.
1991).
The infective consequences of undernutrition are physiologically due to an impaired immune system with a
decreased number of lymphocytes. Wound healing is
impaired due to the inhibition of collagen synthesis and
broblast proliferation. Additionally, increased tissue
Preoperative Optimization
z
The benet of preoperative optimization of the nutritional status remains controversial and still a paucity of
literature exists. In a randomized prospective study
investigating the effect of a multimodal approach to preoperative nutritional supplementation, Alito and de
Aguilar-Nascimento (2016) demonstrated signicantly
reduced hospital stay and decreased C-reactive protein
(CRP) levels in blood on day 2 postoperatively (Alito
and de Aguilar-Nascimento 2016). Nishizaki et al.
(2015) demonstrated that preoperative supplementation
of β-hydroxy-β-methylbutyrate, L-arginine, and
L- glutamine (HMB/Arg/Gln) was protective of quadriceps strength at 2weeks postoperatively in 23 randomized patients undergoing TKA (Nishizaki etal. 2015).
Cao etal. (2017) reported a decreased length of hospital
stays and lower rates of wound ooze in patients who had
received carbohydrate and protein nutritional supplementation preoperatively (Cao et al. 2017). Various
studies have been conducted on nutritional supplementation; however, neither a standardized management
protocol nor parameters indicative of effective treatment are yet to be established.
94
Z. Maharaj and J. R. T. Pietrzak
https://t.me/medicina_free
2
9.5 Overnutrition
In a comparison of obese (BMI > 30 kg/m
) and
non-obese (BMI<30kg/m2) patients undergoing TKA,
In 2017, obesity affected approximately 58% of adults
worldwide, with regional estimates exceeding 70% for
the USA, Chile, and Mexico, respectively (Organisation
for Economic Co-operation and Development (OECD)
2019). In many countries in Africa, a similar develop-
ment is emerging. Obesity is classied according to BMI
with recent additions of subclassications for severe
obesity including morbid obesity and super obesity
Järvenpää etal. (2012) demonstrated signicantly more
postoperative complications in the obese group (Järvenpää et al. 2012). In a review of 1.7 million TKAs,
D’Apuzzo etal. (2015) proved that morbid obesity was
an independent risk factor for perioperative complications (D’Apuzzo etal. 2015). Additionally, having controlled for age, sex, and 28 other medical co-morbidities,
morbid obesity resulted in the following:
(. Table9.1). The incidence of morbidly obese patients
is rising with an increase of 70% between 2000 and 2010
and now accounts for approximately 7% of people in the
USA (Springer et al. 2017; Sturm 2007; Sturm and
Hattori 2013). A direct correlation exists between obesity and the development of osteoarthritis (OA) of the
knee. Obese patients are 3–5times more likely to suffer
5 Prolonged operating times
5 Increased component malpositioning
5 Limited postoperative rehabilitation
5 Increased likelihood of wound dehiscence
5 Higher hospital costs
5 Longer hospital stay (D’Apuzzo etal. 2015)
from knee OA than normal or overweight patients
(Odum et al. 2013; Werner et al. 2015a). It has been
shown that a 4% increase in the incidence of OA exists
9
with each unit increase in age-adjusted BMI. (Bagsby
Furthermore, a dose-dependent relationship exists
between obesity and an increased rate of complications
after TKA.
etal. 2016; Sahyoun etal. 1999)
> Each unit increase of BMI infers an additional 8%
> Subsequently, approximately, 80–95% of patients for
TKA are overweight or obese (Changulani etal. 2008;
Pellegrini etal. 2017).
risk of surgically related complications (Dowsey etal.
2010).
This is both a consequence of obesity itself and the
In addition, the likelihood of obese patients requiring
subsequent contralateral TKA is also signicant. The
need for contralateral TKA after unilateral TKA is 37%
within 10years in obese patients (McMahon and Block
2003; Zeni et al. 2010). In a 2018 review of 85,616
patients, obesity and index TKA were the strongest predictors of the 23.6% of patients requiring contralateral
joint replacement 5–8years later (Lamplot etal. 2018).
increased incidence of associated co-morbidities linked
to obesity. The highest rate of adverse events following
TKA subsequently occurs in super-obese patients
(BMI>50kg/m2). The complication rate in super-obese
patients is not only double that of morbidly obese
patients and four times more signicant than non-obese
patients, it is even higher than those patients undergoing
revision TKA (Werner etal. 2015a).
9.5.1 Associated Risks
Obesity infers a higher risk of perioperative complications including the following:
5 Increased intraoperative blood loss
5 Increased incidence of medial collateral ligament
avulsions
5 Higher risk of PJI
5 Thrombotic events
5 Falls
5 Early failures
5 Subsequent TKA revision surgery (Alvi etal. 2015;
Gillespie and Porteous 2007; Mantilla et al. 2003;
Memtsoudis etal. 2009; Winiarsky etal. 1998)
> Prosthetic longevity may be compromised in obese
patients due to exaggerated stresses on the underlying
bone and implant material (Ayyar etal. 2012; Bagsby
etal. 2016).
Implanted prostheses undergo greater mechanical
strains in patients with higher BMI resulting in increased
wear, poorer survivorship, and a higher demand for subsequent revision TKA for aseptic loosening. Implant
survival is compromised in both primary and revision
TKA in obese patients (Martin etal. 2017). Abdel etal.
(2015) reported an exaggerated risk of tibial prostheses
loosening in obese patients (BMI>35kg/m2) after primary TKA that may be mitigated by the use of additional xation such as stemmed implants (Abdel etal.
2015).
Lifestyle andRisk Factors forKnee Arthroplasty: ASouth African Perspective
https://t.me/medicina_free
95
9
9.5.2 Functional Outcomes
The degree of functional improvement in obese patients
after TKA is controversial. In a comparison of the clinical and radiographic outcomes of 326 TKAs in obese
patients with 425 non-obese patients, Spicer etal. (2001)
reported that no difference existed in both the 10-year
survivorship and functional outcomes of the two groups
(Spicer etal. 2001). Foran etal. (2004) showed that the
functional outcome scores in 68 obese patients were
inferior in comparison to a group of matched non-obese
patients at a mean follow-up of 80months (Foran etal.
2004). In a systematic review, Kerkhoffs et al. (2012)
reported that Knee Society scores (KSS) in obese
patients were signicantly inferior to non-obese patients
by almost 3.23 points on average (Kerkhoffs etal. 2012).
Naziri etal. (2013) showed that both KSS and knee exion was poorer in super-obese patients than non-obese
patients at a 5-year follow-up (Naziri et al. 2013). In
contrast, a retrospective review of the functional outcomes and complications of 402 TKAs using the same
implant by Agarwala etal. (2020) showed no difference
between obese and non-obese patients at a minimum of
1-year follow-up (Agarwala et al. 2020). Collins et al.
(2017), similarly, demonstrated that the perception of
pain and postoperative satisfaction was the same 2years
after TKA irrespective of preoperative BMI (Collins
etal. 2017).
> The absolute functional outcomes of TKA in obese
patients may be less than in non-obese patients but
the relative improvement from preoperative to postoperative outcome scores and satisfaction rates are
equivalent (Bookman etal. 2018).
However, the functional gains are far more moderate
and more gradual as the BMI increases beyond 40kg/m2
and must be juxtaposed with the greater potential of
postoperative complications (Workgroup of the American Association of Hip and Knee Surgeons Evidence
Based Committee 2013).
> In morbidly obese patients the risk of focal osteolysis
on postoperative radiographs is ve times higher with
an increased risk of revision.
Obesity is associated not only with poorer survivorship
of primary TKA but also with a more rapid progression
to early revision surgery (Bookman etal. 2018; Mulhall
etal. 2010). Wagner etal. (2016) analyzed the prospectively collected data of 16,136 patients who underwent
elective primary TKA and reported a signicantly
increased incidence of both re-operation and implant
removal and revision (Wagner et al. 2016). A 3%
increased risk of re-operation and a 5% increased rate
of implant removal and revision accompanied each oneunit increase in BMI, respectively. An increased rate of
revision for aseptic loosening was found in patients with
a BMI>35kg/m2 (Wagner etal. 2016). Functional outcomes are poorer and joint stiffness is more common in
obese than in non-obese patients after revision TKA
(Bookman etal. 2018; Mulhall etal. 2010).
9.5.3 Preoperative Optimization
Weight loss prior to TKA is recommended and may
mitigate the need for TKA by improvement of clinically
relevant symptoms (Martin etal. 2017; Pellegrini etal.
2017). A 10% decrease in body weight is associated with
a reduction of pain and functional disability for patients
with knee OA (Christensen etal. 2007; Flego etal. 2016).
> However, only 1 of 9 patients is able to preoperatively
decrease body weight by more than 5% (Inacio etal.
2014).
Pellegrini et al. (2017) explored patient motives for
weight loss and showed that improving physical appearance was most important followed by the need to alleviate knee symptoms and expedite TKA (Pellegrini etal.
2017).
> Signicant hindrance to weight loss includes compro-
mised mobility and debilitating pain associated with
end-stage knee pathology (Pellegrini etal. 2017).
There is concern that strict preoperative weight loss may
result in muscle weakness and impaired bone mineral
density (Flego etal. 2016; Waters etal. 2013). There is
limited data on the impact of preoperative weight loss
on the outcomes of TKA.
Bariatric surgery (BS) has been suggested to complement diet and exercise to moderate the risks of TKA in
obese patients.
> Bariatric surgery is indicated for morbidly obese
patients and patients with a BMI > 35 kg/m
have failed nonoperative weight loss strategies and
have at least one clinically relevant co-morbidity (Liu
etal. 2020; Zainul-abidin etal. 2019).
2
who
The potential to decrease BMI by 10–15 units and
50–70% of excess weight is possible after BS (Springer
etal. 2017). Today, the safety of BS is equivalent to elective TJA with a mortality rate of 1% (Springer et al.
2017). BS may mitigate the impact of co-morbidities
associated with obesity such as diabetes, hyperlipidemia,
and obstructive sleep apnea (Buchwald etal. 2004; Liu
etal. 2020; Zainul-abidin etal. 2019). The benet of pre-
96
https://t.me/medicina_free
Z. Maharaj and J. R. T. Pietrzak
operative bariatric surgery prior to TKA remains contentious (Springer etal. 2017).
A systematic review and meta-analysis by Sattler etal.
(2019) assessed physiotherapy programs in the acute
post-surgical phase after TKA (Sattler et al. 2019).
> Bariatric surgery has been associated with profound
postoperative nutritional deciencies including
Vitamin D, iron, and albumin (Martin etal. 2017).
There was no signicant difference in functional outcomes across differing regimes after a follow-up at
6 weeks (Dujin et al. 2012; Hewitt and Shakespeare
2001; Kim et al. 2009; Pongkunakorn and Sawatphap
The timing of BS, before or after TKA, is controversial.
Kulkarni etal. (2011) showed that patients who underwent BS before TJA were 3.5 times less likely to have
wound infections and the incidence of hospital readmissions was 7 times lower than for patients with BS after
TJA (Kulkarni etal. 2011). Werner etal. (2015b) reported
that obese patients who had undergone bariatric surgery
2 years before TKA showed a rate of minor complications decreased by 40%, and the incidence of major complications halved in comparison with obese patients
(Werner etal. 2015b). The rate of adverse events was still
higher than compared with non-obese patients undergoing TKA (Werner etal. 2015b). The 2018 Proceedings of
9
International Consensus on Orthopedic Infections do not
recommend routine preoperative bariatric surgery as a
result of inconclusive evidence (Zainul- abidin etal. 2019).
2014). There are several adjuncts to physiotherapy pro-
grams including electrical stimulation, acupuncture,
cryotherapy, and various electrical modalities. Patients
should be educated on these forms of therapy as an
adjunct to an exercise regime offered on a personal preferential basis. However, the adjuncts to physiotherapy
cannot be used in isolation and should be implemented
in conjunction with an exercise routine (Artz etal. 2015).
Various types of exercise such as hydrotherapy, cycling,
or additional balancing movements have shown equivocal outcomes when compared to conventional physiotherapy. There are no signicant differences in outcomes
when outpatient physiotherapy was compared to a
home-based exercise program (Artz et al. 2015; Dujin
et al. 2012; Hewitt and Shakespeare 2001; Kim et al.
2009; Pongkunakorn and Sawatphap 2014; Sattler etal.
2019).
9.6 Rehabilitation TKA
There are big variations between the models of rehabilitation programs used across institutions and by clinicians worldwide. Rehabilitation programs should be
designed to focus on the personal expectations, overall
physical health, and preoperative baseline function of
each patient. There are continued advances in surgery
and between 2012 and 2018 the mean length of hospital stays has decreased from 2.3days to 1.1days in the
USA (American Academy of Orthopaedic Surgeons,
American Joint Replacement Registry (AJRR) 2018).
There are undeniable positive short-term improvements
in physical function and pain after TKA.
> However, there remains a recognized problem with
medium- to long-term patient outcomes.
Despite similar clinical practice, improvement in surgical techniques, and surgeon experience between total
hip arthroplasty (THA) and TKA, the global trend of
patient satisfaction after TKA is more modest than after
THA (Organisation for Economic Co-operation and
Development (OECD) 2019).
> Although most patients receive early, supervised
physiotherapy after TKA, there is a lack of evidence
supporting the optimal type, duration or frequency of
exercise that will ensure the best outcomes (Artz etal.
2015; Sattler etal. 2019).
> After discharge even minimal physiotherapy has been
shown to improve outcomes up to 6months postop-
eratively when compared to a control group receiving
no physiotherapy (Artz etal. 2015).
There is no evidence to suggest which exercise modality
produces best outcomes and clinicians should consider
patient motivation and preference when determining the
most suitable exercise regime to recommend (Castrodad
etal. 2019). The variation in short- term results across
interventions indicates that further high-quality studies
should be conducted to assess the impact of early rehabilitation after TKA over a longer follow-up interval.
The length of hospital stay after TKA rates continues to
decrease worldwide; however, activity during the proceeding days after surgery may have a crucial impact on
long-term outcomes (Artz etal. 2015; Castrodad etal.
2019; Jahic etal. 2018; Sattler etal. 2019).
Conclusion
z
Lifestyle-related risk factors demonstrated to negatively
inuence outcomes including younger age, smoking, and
poor nutritional status. A younger population demographic is presenting for TKA with increased desires to
RTW and RTS. There are no absolute restrictions on
activities after TKA, and surgeons should consider each
case on an individual basis to provide extensive counseling aimed at guiding patients. A multidisciplinary team
approach should be implemented to ensure that patient
expectations are met. The overall patient satisfaction
Lifestyle andRisk Factors forKnee Arthroplasty: ASouth African Perspective
https://t.me/medicina_free
97
9
after TKA is more modest than after THA and the vital
role of perioperative rehabilitation and optimization of
modiable risk factors must be recognized.
Take-Home Messages
5 There is increased demand for TKA in a younger
demographic (<60years) with increased expectations after TKA.
5 Younger patients have shown the highest incidence
of need for early revisions after TKA.
5 RTW and RTS are now major expectations that
have been strongly correlated with patient satisfaction.
5 Smoking is a modiable patient risk factor with an
increased risk for revision TKA when compared to
patients who have never smoked.
5 Malnutrition, including both undernutrition and
obesity, is implicated in a higher risk of overall
complications, readmissions, and revisions.
5 Undernutrition is often overlooked and underdi-
agnosed affecting between 40% and 60% of TJA
patients.
5 A low preoperative serum albumin of <3.5 g/dL
may be an accurate indicator of postoperative
infections.
5 Although satisfaction rates are equivalent to non-
obese patients, functional outcomes are lower in
obese patients after TKA.
5 Obesity may compromise prosthetic longevity due
to exaggerated stresses on the underlying bone and
implant material.
5 Obesity is the strongest predictor of requiring con-
tralateral joint replacement within 5 to 8 years
after index TKA.
5 Perioperative rehabilitation programs directly impact
early and medium-term functional outcomes and a
multidisciplinary team approach to optimize patient
satisfaction after TKA.
References
Abdel MP, Bonadurer GF, Jennings MT, Hanssen AD (2015)
Increased aseptic tibial failures in patients with a BMI ≥35 and
well-aligned total knee arthroplasties. J Arthroplast 30(12):2181–
2184. https://doi.org/10.1016/j.arth.2015.06.057
Agarwala S, Jadia C, Vijayvargiya M (2020) Is obesity a contra-
indication for a successful total knee arthroplasty? J Clin Orthop
Trauma 11(1):136–139. https://doi.org/10.1016/j.jcot.2018.
11.016
Alito MA, de Aguilar-Nascimento JE (2016) Multimodal periopera-
tive care plus immunonutrition versus traditional care in total
hip arthroplasty: a randomized pilot study. Nutr J 15:34. https://
doi.org/10.1186/s12937- 016- 0153- 1
Alvi HM, Mednick RE, Krishnan V, Kwasny MJ, Beal MD, Manning
DW (2015) The effect of BMI on 30 day outcomes following
total joint arthroplasty. J Arthroplast 30(7):1113–1117. https://
doi.org/10.1016/j.arth.2015.01.049
American Academy of Orthopaedic Surgeons, American Joint
Replacement Registry (AJRR) (2018) Fifth AJRR annual report
on hip and knee arthroplasty data. Downloaded from http://con-
nect.ajrr.net/2019-ajrr-annual-report (7 Jan 2020)
Artz N, Elvers KT, Lowe CM, Sackley C, Jepson P, Beswick AD
(2015) Effectiveness of physical therapy exercise following total
knee replacement: systematic review and meta-analysis. BMC
Musculoskelet Disord 16:15. https://doi.org/10.1186/s12891-
015- 0469- 6
Ayyar V, Burnett R, Coutts FJ, van der Linden ML, Mercer TH
(2012) The inuence of obesity on patient reported outcomes
following total knee replacement. Arthritis 2012:185208. https://
doi.org/10.1155/2012/185208
Bagsby DT, Issa K, Smith LS, Elmallah RK, Mast LE, Harwin SF
etal (2016) Cemented vs cementless total knee arthroplasty in
morbidly obese patients. J Arthroplast 31(8):1727–1731. https://
doi.org/10.1016/j.arth.2016.01.025
Bala A, Ivanov DV, Huddleston JI, Goodman SB, Maloney WJ,
Amanatullah DF (2020) The cost of malnutrition in total
joint arthroplasty. J Arthroplast 35(4):926–932, e1. https://doi.
org/10.1016/j.arth.2019.11.018
Barber-Westin SD, Noyes FR (2016) Aerobic physical tness and
recreational sports participation after total knee arthroplasty:
a systematic review. Sports Health 8(6):553–560. https://doi.
org/10.1177/1941738116670090
Bardgett M, Lally J, Malviya A, Kleim B, Deehan D (2016) Patient-
reported factors inuencing return to work after joint replace-
ment. Occup Med (Lond) 66(3):215–221
Blevins K, Aalirezaie A, Shohat N, Parvizi J (2018) Malnutrition
and the development of periprosthetic joint infection in
patients undergoing primary elective total joint arthroplasty.
J Arthroplast 33(9):2971–2975. https://doi.org/10.1016/j.arth.
2018.04.027
Bookman JS, Schwarzkopf R, Rathod P, Iorio R, Deshmukh AJ
(2018) Obesity. Orthop Clin North Am 49(3):291–296. https://
doi.org/10.1016/j.ocl.2018.02.002
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W,
Fahrbach K etal (2004) Bariatric surgery. JAMA 292(14):1724–
1737
Cao G, Huang Q, Xu B, Huang Z, Xie J, Pei F (2017) Multimodal
nutritional management in primary total knee arthroplasty: a
randomized controlled trial. J Arthroplast 32(11):3390–3395.
https://doi.org/10.1016/j.arth.2017.06.020
Carli AV, Polascik BA, Stelmaszczyk K, Haas SB (2019) What is the
status? A systematic review of nutritional status research in total
joint arthroplasty. Tech Orthop 34(3):155–162
Castrodad IMD, Recai TM, Abraham MM, Etcheson JI, Mohamed
NS, Edalatpour A etal (2019) Rehabilitation protocols follow-
ing total knee arthroplasty: a review of study designs and out-
come measures. Ann Transl Med 7(Suppl 7):S255.
org/10.21037/atm.2019.08.15
Changulani M, Kalairajah Y, Peel T, Field RE (2008) The relation-
ship between obesity and the age at which hip and knee replace-
ment is undertaken. J Bone Joint Surg Br 90(3):360–363. https://
doi.org/10.1302/0301- 620X.90B3.19782
Christensen R, Bartels EM, Astrup A, Bliddal H (2007) Effect of
weight reduction in obese patients diagnosed with knee osteoar-
thritis: a systematic review and meta-analysis. Ann Rheum Dis
66(4):433–439
Collins JE, Donnell-Fink LA, Yang HY, Usiskin IM, Lape EC,
Wright J etal (2017) Effect of obesity on pain and functional
recovery following total knee arthroplasty. J Bone Joint Surg Am
99(21):1812–1818. https://doi.org/10.2106/JBJS.17.00022
https://doi.
98
https://t.me/medicina_free
Z. Maharaj and J. R. T. Pietrzak
Courtney PM, Rozell JC, Melnic CM, Sheth NP, Nelson CL (2016)
Effect of malnutrition and morbid obesity on complication rates
following primary total joint arthroplasty. J Surg Orthop Adv
25(2):99–104
D’Apuzzo MR, Novicoff WM, Browne JA (2015) The John Insall
award: morbid obesity independently impacts complications,
mortality, and resource use after TKA.Clin Orthop Relat Res
473(1):57–63
Dowsey MM, Liew D, Stoney JD, Choong PF (2010) The impact
of pre-operative obesity on weight change and outcome in total
knee replacement. J Bone Joint Surg Br 92(4):513–520. https://
doi.org/10.1302/0301- 620X.92B4.23174
Dujin P, Jeonghee K, Hyunok L (2012) Effectiveness of modied
quadriceps Femoris muscle setting exercise for the elderly in
early rehabilitation after Total knee arthroplasty. J Phys Ther
Sci 24(1):27–30
Flego A, Dowsey MM, Choong PFM, Moodie M (2016) Addressing
obesity in the management of knee and hip osteoarthritisweighing in from an economic perspective. BMC Musculoskelet
Disord 17:233. https://doi.org/10.1186/s12891- 016- 1087- 7
Foran JRH, Mont MA, Etienne G, Jones LC, Hungerford DS (2004)
The outcome of total knee arthroplasty in obese patients. J Bone
Joint Surg Am 86(8):1609–1615
Garber CE, Blissmer B, Deschenes MR et al (2011) American
9
College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory,
musculoskeletal, and neuromotor tness in apparently healthy
adults: guidance for prescribing exercise. Med Sci Sports Exerc
43:1334–1359
Gerhard P, Bolt R, Duck K, Mayer R, Friederich NF, Hirschmann
MT (2013) Long-term results of arthroscopically assisted anatomical single-bundle anterior cruciate ligament reconstruction
using patellar tendon autograft: are there any predictors for the
development of osteoarthritis? Knee Surg Sports Traumatol
Arthrosc 21:957–964
Gillespie GN, Porteous AJ (2007) Obesity and knee arthroplasty.
Knee 14(2):81–86
Golant A, Christoforou DC, Slover JD, Zuckerman JD (2010)
Athletic participation after hip and knee arthroplasty. Bull NYU
Hosp Jt Dis 68:76–83
Granan LP, Bahr R, Lie SA, Engebretsen L (2009) Timing of ante-
rior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the
Norwegian National Knee Ligament Registry. Am J Sports Med
37:955–961
Greene KA, Wilde AH, Stulberg BN (1991) Preoperative nutritional
status of total joint patients. Relationship to postoperative
wound complications. J Arthroplast 6(4):321–325
Harding P, Holland AE, Delany C, Hinman RS (2014) Do activity
levels increase after total hip and knee arthroplasty? Clin Orthop
Relat Res 472:1502–1511
Haskell WL, Lee IM, Pate RR etal (2007) Physical activity and
public health: updated recommendation for adults from the
American College of Sports Medicine and the American Heart
Association. Circulation 116:1081–1093
Healy WL, Sharma S, Schwartz B, Iorio R (2008) Athletic activ-
ity after total joint arthroplasty. J Bone Joint Surg Am 90:
2245–2252
Hewitt B, Shakespeare D (2001) Flexion vs. extension: a comparison
of post-operative total knee arthroplasty mobilisation regimes.
Knee 8(4):305–309
Hopper GP, Leach WJ (2008) Participation in sporting activities fol-
lowing knee replacement: total versus unicompartmental. Knee
Surg Sports Traumatol Arthrosc 16:973–979
Huang R, Greenky M, Kerr GJ, Austin MS, Parvizi J (2013) The
effect of malnutrition on patients undergoing elective joint
arthroplasty. J Arthroplast 28(8):21–24
Inacio MCS, Kritz-Silverstein D, Raman R, Macera CA, Nichols JF,
Shaffer RA etal (2014) The risk of surgical site infection and re-
admission in obese patients undergoing total joint replacement
who lose weight before surgery and keep it off post- operatively.
Bone Joint J 96-B(5):629–635. https://doi.org/10.1302/0301-
620X.96B5.33136
Jahic D, Omerovic D, Tanovic AT, Dzankovic F, Campara MT
(2018) The effect of prehabilitation on postoperative outcome
in patients following primary total knee arthroplasty. Med Arch
72(6):439–443. https://doi.org/10.5455/medarh.2018.72.439- 443
Jain NB, Higgins LD, Ozumba D etal (2005) Trends in epidemiology
of knee arthroplasty in the United States, 1990–2000. Arthritis
Rheum 52:3928–3933
Järvenpää J, Kettunen J, Soininvaara T, Miettinen H, Kröger H
(2012) Obesity has a negative impact on clinical outcome after
total knee arthroplasty. Scand J Surg 101(3):198–203
Johnston SS, Ammann E, Scamuffa R, Samuels J, Stokes A,
Fegelman E etal (2020) Association of body mass index and
osteoarthritis with healthcare expenditures and utilization. Obes
Sci Pract 6(2):139–151. https://doi.org/10.1002/osp.398
Jones RE, Russell RD, Huo MH (2013) Wound healing in total joint
replacement. Bone Joint J 95-B(11 Suppl A):144–147. https://
doi.org/10.1302/0301- 620X.95B11.32836
Kamath AF, McAuliffe CL, Kosseim LM, Hume E, Pio F (2016)
Malnutrition in joint arthroplasty: prospective stud indicates risk
of unplanned ICU admission. Arch Bone Jt Surg 4(2):128–131
Kerkhoffs GMMJ, Servien E, Dunn W, Dahm D, Bramer JAM,
Haverkamp D (2012) The inuence of obesity on the compli-
cation rate and outcome of total knee arthroplasty: a meta-
analysis and systematic literature review. J Bone Joint Surg Am
94(20):1839–1844. https://doi.org/10.2106/JBJS.K.00820
Kievit AJ, van Geenen RC, Kuijer PP, Pahlplatz TM, Blankevoort
L, Schafroth MU (2014) Total knee arthroplasty and the unfore-
seen impact on return to work: a cross-sectional multicenter sur-
vey. J Arthroplast 29(6):1163–1168
Kim T, Park K, Yoon S, Kim S, Chang C, Seong S (2009) Clinical
value of regular passive ROM exercise by a physical therapist
after total knee arthroplasty. Knee Surg Sports Traumatol
Arthrosc 17(10):1152–1158
Kulkarni A, Jameson SS, James P, Woodcock S, Muller S, Reed MR
(2011) Does bariatric surgery prior to lower limb joint replace-
ment reduce complications? Surgeon 9(1):18–21. https://doi.
org/10.1016/j.surge.2010.08.004
Lamplot JD, Bansal A, Nguyen JT, Brophy RH (2018) Risk of
subsequent joint arthroplasty in contralateral or different joint
after index shoulder, hip, or knee arthroplasty: association with
index joint, demographics, and patient-specic factors. J Bone
Joint Surg Am 100(20):1750–1756. https://doi.org/10.2106/
JBJS.17.00948
Liu JX, Paoli AR, Mahure SA, Bosco J, Campbell KA (2020)
Preoperative bariatric surgery utilization is associated with
increased 90-day postoperative complication rates after total
joint arthroplasty. J Am Acad Orthop Surg 28(5):e206–e212.
https://doi.org/10.5435/JAAOS- D- 18- 00381
Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL
(2003) Risk factors for clinically relevant pulmonary embolism
and deep venous thrombosis in patients undergoing primary hip
or knee arthroplasty. Anesthesiology 99(3):552–560
Martin JR, Jennings JM, Dennis DA (2017) Morbid obesity and
total knee arthroplasty. J Am Acad Orthop Surg 25(3):188–194.
https://doi.org/10.5435/JAAOS- D- 15- 00684
Lifestyle andRisk Factors forKnee Arthroplasty: ASouth African Perspective
https://t.me/medicina_free
99
9
McGonagle L, Convery-Chan L, DeCruz P etal (2019) Factors inu-
encing return to work after hip and knee arthroplasty. J Orthop
Traumatol 20:9. https://doi.org/10.1186/s10195- 018- 0515- x
McMahon M, Block JA (2003) The risk of contralateral total
knee arthroplasty after knee replacement for osteoarthritis. J
Rheumatol 30(8):1822–1824
Memtsoudis SG, Besculides MC, Gaber L, Liu S etal (2009) Risk
factors for pulmonary embolism after hip and knee arthroplasty:
a population-based study. Int Orthop 33(6):1739–1745. https://
doi.org/10.1007/s00264- 008- 0659- z
Mulhall K, Ghomrawi H, Mihalko W, Cui Q, Saleh K (2010) Adverse
effects of increased body mass index and weight on survivorship
of total knee arthroplasty and subsequent outcomes of revision
TKA.J Knee Surg 20(03):199–204
National Joint Registry 16th Annual Report (2019) Published 31
December 2019. NJR editorial board. Downloaded from https://
reports.njrcentre.org.uk (7 Jan 2020)
Naziri Q, Issa K, Malkani AL, Bonutti PM, Harwin SF, Mont
MA (2013) Bariatric orthopaedics: total knee arthroplasty in
super- obese patients (BMI>kg/m2). Survivorship and complications. Clin Orthop Relat Res 471(11):3523–3530. https://doi.
org/10.1007/s11999- 013- 3154- 9
Nishizaki K, Ikegami H, Tanaka Y, Imai R, Matsumura H (2015)
Effects of supplementation with a combination of β-hydroxyβ- methyl butyrate, L-arginine, and L-glutamine on postoperative recovery of quadriceps muscle strength after total knee
arthroplasty. Asia Pac J Clin Nutr 24(3):412–420. https://doi.
org/10.6133/apjcn.2015.24.3.01
Odum SM, Springer BD, Dennos AC, Fehring TK (2013) National
obesity trends in total knee arthroplasty. J Arthroplast 28(8
Suppl):148–151. https://doi.org/10.1016/j.arth.2013.02.036
Organisation for Economic Co-operation and Development (OECD)
(2019) Health at a glance 2019: OECD indicators. OECD
Publishing, Paris. https://doi.org/10.1787/4dd50c09- en
Pellegrini CA, Ledford G, Hoffman SA, Chang RW, Cameron KA
(2017) Preferences and motivation for weight loss among knee
replacement patients: implications for a patient-centered weight
loss intervention. BMC Musculoskelet Disord 18(1):327. https://
doi.org/10.1186/s12891- 017- 1687- x
Pongkunakorn A, Sawatphap D (2014) Use of drop and dangle
rehabilitation protocol to increase knee exion following total
knee arthroplasty: a comparison with continuous passive motion
machine. J Med Assoc Thail 97(Suppl 9):S16–S22
Ryan SP, Politzer C, Green C, Wellman S, Bolognesi M, Seyler T
(2018) Albumin versus American society of anesthesiologists
score: which is more predictive of complications following total
joint arthroplasty? Orthopedics 41(6):354–362. https://doi.
org/10.3928/01477447- 20181010- 05
Sahyoun NR, Hochberg MC, Helmick CG, Harris T, Pamuk ER
(1999) Body mass index, weight change, and incidence of selfreported physician-diagnosed arthritis among women. Am J
Public Health 89(3):391–394
Sattler LN, Hing WA, Vertullo CJ (2019) What is the evidence to
support early supervised exercise therapy after primary total
knee replacement? A systematic review and meta-analysis. BMC
Musculoskelet Disord 20:42. https://doi.org/10.1186/s12891-
019- 2415- 5
Sayeed Z, Anoushiravani AA, Simha S, Padela MT, Schafer P, Awad
ME et al (2019) Markers for malnutrition and BMI status in
total joint arthroplasty and pharmaconutrient therapy. JBJS
Rev 7(5):1–9
Schroer WC, Diesfeld PJ, LeMarr AR, Morton DJ, Reedy ME (2018)
Modiable risk factors in primary joint arthroplasty increase
90-day cost of care. J Arthroplast 33(9):2740–2744
Sharma R, Ardebili MA, Abdulla IN (2019) Does rehabilitation
before total knee arthroplasty benet postoperative recovery? A
systematic review. Indian J Orthop 53(1):138–147
Sloan M, Premkumar A, Sheth NP (2018) Projected volume of
primary total joint arthroplasty in the U.S., 2014 to 2030. J
Bone Joint Surg Am 100:1455–1460. https://doi.org/10.2106/
JBJS.17.01617
Spicer DD, Pomeroy DL, Badenhausen WE, Schaper LA, Curry JI,
Suthers KE etal (2001) Body mass index as a predictor of out-
come in total knee replacement. Int Orthop 25(4):246–249
Springer BD, Carter JT, Mclawhorn AS, Scharf K, Roslin M, Kallies
KJ etal (2017) Obesity and the role of bariatric surgery in the
surgical management of osteoarthritis of the hip and knee: a
review of the literature. Surg Obes Relat Dis 13(1):111–118.
https://doi.org/10.1016/j.soard.2016.09.011
Sturm R (2007) Increases in morbid obesity in the USA: 2000–2005.
Public Health 121(7):492–496
Sturm R, Hattori A (2013) Morbid obesity rates continue to rise rap-
idly in the United States. Int J Obes 37(6):889–891
Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang
G, Ziegler TR (2013) Critical role of nutrition in improving
quality of care. JPEN J Parenter Enteral Nutr 37(4):482–497.
https://doi.org/10.1177/0148607113484066
Tilbury C, Schaasberg W, Plevier JWM, Fiocco M, Nelissen
RGHH, Vlieland V etal (2014) Return to work after total hip
and knee arthroplasty: a systematic review. Rheumatology
53(3):512–525
Tobert CM, Mott SL, Nepple KG (2018) Malnutrition diagnosis
during adult inpatient hospitalizations: analysis of a multi-
institutional collaborative database of academic medical cen-
ters. J Acad Nutr Diet 118(1):125–131. https://doi.org/10.1016/j.
jand.2016.12.019
Tsantes AG, Papadopoulos DV, Lytras T, Tsantes AE, Mavrogenis
AF, Korompilias AV et al (2019) Association of malnutrition
with periprosthetic joint and surgical site infections after total
joint arthroplasty: a systematic review and meta-analysis. J Hosp
Infect 103(1):69–77. https://doi.org/10.1016/j.jhin.2019.04.020
van Zaanen Y, van Geenen RCI, Pahlplatz TMJ (2019) Three out
of ten working patients expect no clinical improvement of their
ability to perform work-related knee-demanding activities after
total knee arthroplasty: a multicenter study. J Occup Rehabil
29:585–594. https://doi.org/10.1007/s10926- 018- 9823- 5
Vielgut I, Leitner L, Kastner N, Radl R, Leithner A, Sadoghi P
(2016) Sports activity after low-contact stress total knee arthro-
plasty– a long term follow-up study. Sci Rep 6:24630. https://
doi.org/10.1038/srep24630
Wagner ER, Kamath AF, Fruth K, Harmsen WS, Berry DJ (2016)
Effect of body mass index on reoperation and complications
after total knee arthroplasty. J Bone Joint Surg Am 98(24):2052–
2060. https://doi.org/10.2106/JBJS.16.00093
Waters DL, Ward AL, Villareal DT (2013) Weight loss in obese adults
65years and older: a review of the controversy. Exp Gerontol
48(10):1054–1061. https://doi.org/10.1016/j.exger.2013.02.005
Werner BC, Evans CL, Carothers JT, Browne JA (2015a) Primary
total knee arthroplasty in super-obese patients: dramatically
higher postoperative complication rates even compared to revi-
sion surgery. J Arthroplast 30(5):849–853
Werner BC, Kurkis GM, Gwathmey FW, Browne JA (2015b) Bariatric
surgery prior to total knee arthroplasty is associated with fewer
postoperative complications. J Arthroplast 30(9 Suppl):81–85.
https://doi.org/10.1016/j.arth.2014.11.039
Winiarsky R, Barth P, Lotke P (1998) Total knee arthroplasty in
morbidly obese patients. J Bone Joint Surg Am 80(12):1770–1774
100
https://t.me/medicina_free
Z. Maharaj and J. R. T. Pietrzak
Workgroup of the American Association of Hip and Knee Surgeons
Evidence Based Committee (2013) Obesity and total joint arthroplasty. J Arthroplast 28(5):714–721. https://doi.org/10.1016/j.
arth.2013.02.011
World Health Organisation (WHO) (2018) [Internet] https://
www. who. int/news- room/fact- sheets/detail/malnutrition (Last
updated 16 February 2018) (Last accessed 28 March 2020)
Zainul-abidin S, Amanatullah DF, Anderson MB, Barretto M,
Battenberg A, Austin M et al (2019) General assembly, preven-
tion, host related general: proceedings of international consen-
sus on orthopedic infections. J Arthroplast 34(2S):S13–S35.
https://doi.org/10.1016/j.arth.2018.09.050
Zeni JA, Snyder-Mackler L, Snyder-Mackler L (2010) Most patients
gain weight in the 2 years after total knee arthroplasty: compari-
son to a healthy control group. Osteoarthr Cartil 18(4):510–514.
https://doi.org/10.1016/j.joca.2009.12.005
9
101
https://t.me/medicina_free
The Microbiome oftheJoint
SamuelJ.Clarkson, KaranGoswami, andJavadParvizi
Contents
10.1 Microbiome Overview – 102
10.2 Clinical Signicance ofMicrobiome – 102
10.3 Microbiome in“Sterile” Compartments – 102
10.4 Chronic Colonization oftheNative Joint – 103
10.5 Colonization ofNative/Implanted Joint Without Evidence
ofDisease – 104
10.6 Implications forPJI – 104
10
References – 105
© The Author(s), under exclusive license to Springer-Verlag GmbH, DE, part of Springer Nature 2022
E. Hansen, K.-D. Kühn (eds.), Essentials of Cemented Knee Arthroplasty,
https://doi.org/10.1007/978-3-662-63113-3_10
102
https://t.me/medicina_free
S. J. Clarkson et al.
10
10.1 Microbiome Overview
Over the past several decades, it has become clear that
the microorganisms that reside in ecological niches of
the human body play an important role in health and
disease (Byrd et al. 2018; Cho and Blaser 2012;
Davenport etal. 2017; Young 2017). This community of
microorganisms comprises part of what is known as the
human microbiome, a term that encompasses the composition of all microbial genes in a community, as well
as host epithelium, immune components, and both host
and microbe metabolites (Byrd etal. 2018; Young 2017).
In all, the human microbiome is estimated to contain
over 1013 cells, outnumbering human cells by 10:1
according to some estimates (Sender et al. 2016).
Bacteria, especially in the digestive tract, have been by
far the most studied component of the microbiome.
However, other organisms including fungi, viruses, and
protozoa all play important roles. Moreover, the specic
composition of species differs vastly in different areas of
the body (Cho and Blaser 2012).
The study of the microbiome has taken off in large
part due to improvements in the ability of new technologies to characterize the diverse array of microorganisms. Prior to DNA sequencing technology, our ability
to identify the multitude of species was limited as standard culturing techniques are unable to detect over 80%
of the microorganisms within the human microbiome
(Clemente etal. 2018; Eckburg etal. 2005). Utilizing the
relative consistency of the 16S rRNA subunit of the
bacterial genome, culture-independent approaches have
allowed researchers to rapidly sequence the enormous
amount of genetic data contained within a given sample
(Clemente et al. 2018; Goswami and Parvizi 2020;
Hodkinson and Grice 2015). For example, technologies
based on polymerase chain reaction (PCR) were groundbreaking in detecting and classifying components of the
human genome and microbiome, as well as diagnosing
infections in a clinical context. However, PCR is limited
by its relatively low sensitivity and reliance on preconceived primer targets. In more recent years, non-Sangerbased high throughput DNA sequencing methods,
collectively referred to as next-generation sequencing
(NGS), have shown promise in its ability to quickly and
accurately characterize all microbial DNA in a given
sample without suffering from the limitations inherent
to PCR (Goswami et al. 2018; Goswami and Parvizi
2020).
10.2 Clinical Signicance ofMicrobiome
The advances as described have begun to provide
researchers with a more comprehensive picture of the
human microbiome. This work has made it clear, in
recent decades, that characteristics of specic components of the microbiome are linked to certain pathologies. In particular, the microbiome of the digestive tract
has been studied extensively. Within the realm of infectious diseases, there is an increased understanding that
the composition of the gut microbiome mediates resistance to colonization of invasive species.
> As such an indirect path to infection can be exploited
by certain species when dysbiosis occurs.
A prominent example is the ability of Clostridium dif-
cile to colonize and cause disease in individuals whose
microbiome has been affected by the administration of
antibiotics (Libertucci and Young 2019). There is also
substantial evidence of the microbiome’s role in oncogenesis within the digestive tract, including associations
with the development of gastric adenocarcinoma
(Atherton and Blaser 2009), esophageal adenocarcinoma (Atherton and Blaser 2009), and colorectal carcinoma (Castellarin etal. 2012; Kostic etal. 2012).
The effect of the gut microbiome is not limited to
local organs. Through regulation of nutritional absorption, regulation of the gut’s immune system, and translocation of microbes into the systemic circulation, the
composition of the microbiome inuences disease systemically and at specic distant organs (Hernandez
2017). Variations have been implicated in a wide array
of diseases, including cardiovascular disease (Wang
etal. 2011), obesity (Ley et al. 2005; Turnbaugh etal.
2006), psychiatric illness (Bravo etal. 2011; Dinan and
Cryan 2013), multiple sclerosis (Clemente etal. 2018),
and systemic lupus erythematosus (Clemente et al.
2018). Of note, there is also evidence to support the
inuence of the gut microbiome on bone and joint diseases such as inammatory arthritis, osteoarthritis, and
osteoporosis (Clemente et al. 2018; Hernandez 2017;
Hernandez etal. 2019; Scher etal. 2016).
10.3 Microbiome in“Sterile” Compartments
> The microbiome of the digestive tract, skin, and other
locations are considered to be commensal and consis-
tent with normal physiology. Disruptions in the com-
position of the microbiome lead to disease, not the
mere existence of organisms.
In contrast, there are many areas of the body, such as
joints, that are traditionally considered to be sterile.
Detection of microorganisms in these locations is often
considered contaminants or markers of specic pathologies that have developed due to immune suppression or
implantation of a foreign material (Rohde and Goswami n.d.).
Соседние файлы в папке Библиотека им академика М.И. Перельмана