Knee Surg Relat Res.  2018 Dec;30(4):319-325. 10.5792/ksrr.18.025.

Prospective Study of Central versus Peripheral Obesity in Total Knee Arthroplasty

• Armstrong
• Morris TR
• Sebro R
• Israelite
• Kamath AF

• KMID: 2438112
• DOI: http://doi.org/10.5792/ksrr.18.025

Abstract

PURPOSE
Body mass index (BMI) is often used to predict surgical difficulty in patients receiving total knee arthroplasty (TKA); however, BMI neglects variation in the central versus peripheral distribution of adipose tissue. We sought to examine whether anthropometric factors, rather than BMI alone, may serve as a more effective indication of surgical difficulty in TKA.
MATERIALS AND METHODS
We prospectively enrolled 67 patients undergoing primary TKA. Correlation coefficients were used to evaluate the associations of tourniquet time, a surrogate of surgical difficulty, with BMI, pre- and intraoperative anthropometric measurements, and radiographic knee alignment. Similarly, Knee Injury and Osteoarthritis Outcome Score (KOOS) was compared to BMI.
RESULTS
Tourniquet time was significantly associated with preoperative inferior knee circumference (p=0.025) and ankle circumference (p=0.003) as well as the intraoperative depth of incision at the quadriceps (p=0.014). BMI was not significantly associated with tourniquet time or any of the radiographic parameters or KOOS scores.
CONCLUSIONS
Inferior knee circumference, ankle circumference, and depth of incision at the quadriceps (measures of peripheral obesity) are likely better predictors of surgical difficulty than BMI. Further study of alternative surgical indicators should investigate patients that may be deterred from TKA for high BMI, despite relatively low peripheral obesity.

Keyword

Knee; Arthroplasty; Obesity; Anthropometry

MeSH Terms

Adipose Tissue
Ankle
Anthropometry
Arthroplasty
Arthroplasty, Replacement, Knee*
Body Mass Index
Humans
Knee
Knee Injuries
Obesity*
Osteoarthritis
Prospective Studies*
Tourniquets