| This thesis deals with obesity and its influence on the outcome after total knee arthroplasty. Obesity is generally seen as being too fat or overweight. Obesity has long been linked to the development of osteoarthritis of the knee joint. The incidence of obesity is raising worldwide, both in developed and developing nations. Moreover, it is among the risk factors for developing osteoarthritis in the knee. Obesity and knee osteoarthritis are both independently disabling conditions and in combination, causes severe pain in patients and poses difficulty in treatment and management challenges.Body mass index (BMI) is the standard assessment to measure obesity. The BMI is calculated by dividing the subject’s weight in kilogram by their height in meter squared, which correlates with the amount of body fat. According to the World Health Organization (WHO), individuals who have a BMI of 25 to 29.9 are overweight. Obese individuals are those with a BMI greater than, or equal to 30. This category is then subdivided into three classes Class â… is a BMI of between 30 and 34.9; Class â…¡ is a BMI of between 35 and 39.9; and Class â…¢ is a BMI greater than, or equal to 40. A high BMI exerts sustainable amount of pressure and stress on the body joint, especially the knee, causing degradation of the knee joint cartilage leading to Osteoarthritis (OA) of the knee joint. Osteoarthritis of the knee, one of the most common causes of disability and stiffness of the knee joints, continues to increase in prevalence in the older and obese populations. The rising number of obesity is a huge contributing factor to the degeneration of the knee joint as a result of body weight exerted on it. Therefore, the demand for total knee replacements or total knee arthroplasty (TKA) has risen and is expected to continue rising.This increase in demand for TKA can be attributed to the increased diagnosis of Osteoarthritis. Moreover, failures of TKA in obese patients are highly owned to the stress and load across the knee joint. These failures are attributed to aseptic loosening patellar complications and instability. Polyethylene wear and a foreign body reaction with an associated osteolysis around TKA implants have been regarded as significant problems after TKA. Revision in TKA is a surgical procedure to restore the original anatomy of the knee, regain function, and provide stability.The first work of this thesis was a systematic explanation of obesity, prevalence, measurement of individual BMI and its relationship to osteoarthritis.The second and the third work focus on the correlation between Osteoarthritis and Total Knee Arthroplasty, prevalence and treatment options. This includes surgery and revision of TKA in failure situation and the rate at which TKA was conducted within some developed countries, with total population 742 million and an estimated 1183 annual primary and revision total knee procedure.In the final part, the thesis elaborates the result of 256 total knee arthroplasty on 182 patients at a mean of 4years with high patellofemoral symptoms in the obese patients. Thirty percent of the 43 were moderately to severely obese individual with patellofemoral symptoms.14 percent of the 31 were under weight to mildly obese individuals with less patellofemoral symptoms. Their influence of increased body mass index (BMI) on total knee arthroplasty was compared, to the outcome of TKA in series of obese, morbid obese and non-obese patients. Obese patients had a lower success rate and lower postoperative knee society scores and, therefore, lower satisfaction levels. Overall, it appears that obesity has a negative impact on the results of total knee arthroplasty, with morbid obesity having an even more dramatic negative effect with regard to revision rates after total knee arthroplasty. |
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