Total knee arthroplasty in patients with severe obesity: outcomes of standard keeled tibial components versus stemmed universal base plates

• Published in: Knee surgery & related research 2023-04, Vol.35 (1), p.9-9, Article 9
• Main Authors: Elcock, Katherine L, MacDonald, Deborah J, Clement, Nick D, Scott, Chloe E H
• Format: Article
• Language: English
• Subjects: Arthritis; Aseptic loosening; Body mass index; Clinical outcomes; Comorbidity; Geometry; Joint replacement surgery; Knee; Obesity; Osteoarthritis; Pain; Patient satisfaction; Questionnaires; Surgeons; Survival analysis; Tibial baseplate; Total knee arthroplasty; Variables; Varus alignment
• ISSN: 2234-0726; 2234-2451; 2234-2451
• DOI: 10.1186/s43019-023-00184-4

Patients with severe obesity [body mass index (BMI) ≥ 40 kg/m ] potentially overload the tibial component after total knee arthroplasty (TKA), risking tibial subsidence. Using a cemented single-radius cruciate-retaining TKA design, this study compared the outcomes of two tibial baseplate geometries in patients with BMI ≥ 40 kg/m : standard keeled (SK) or universal base plate (UBP), which incorporates a stem. This was a retrospective, single-centre cohort study with minimum 2 years follow-up of 111 TKA patients with BMI ≥ 40 kg/m : mean age 62.2 ± 8.0 (44-87) years, mean BMI 44.3 ± 4.6 (40-65.7) kg/m and 82 (73.9%) females. Perioperative complications, reoperations, alignment and patient-reported outcomes (PROMS): EQ-5D, Oxford Knee Score (OKS), Visual Analogue Scale (VAS) pain score and satisfaction were collected preoperatively, and at 1 year and final follow-up postoperatively. Mean follow-up was 4.9 years. SK tibial baseplates were performed in 57 and UBP in 54. There were no significant differences in baseline patient characteristics, post-operative alignment, post-operative PROMs, reoperations or revisions between the groups. Three early failures requiring revision occurred: two septic failures in the UBP group and one early tibial loosening in the SK group. Five-year Kaplan-Meier survival for the endpoint mechanical tibial failure was SK 98.1 [94.4-100 95% confidence interval (CI)] and UBP 100% (p = 0.391). Overall varus alignment of the limb (p = 0.005) or the tibial component (p = 0.031) was significantly associated with revision and return to theatre. At early to mid-term follow-up, no significant differences in outcomes were found between standard and UBP tibial components in patients with BMI ≥ 40 kg/m . Varus alignment of either tibial component or the limb was associated with revision and return to theatre.