ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2136

Does Functional Gain and Pain Relief After TKR and THR Differ By Patient Obese Status?

Wenjun Li1, Leslie R. Harrold2, Jeroan Allison3, Courtland Lewis4, Thomas Bowen5, Patricia D. Franklin1 and David Ayers1, 1Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, 2University of Massachusetts Medical School, Worcester, MA, 3Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 4Hartford Hospital, Hartford, CT, 5Geisinger, Danville, PA

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Title: Osteoarthritis - Clinical Aspects II: Symptoms and Therapeutics in Osteoarthritis.

Session Type: Abstract Submissions (ACR)

Background/Purpose: Obesity is an important predictor of functional status and pain after total knee (TKR) and total hip (THR) replacement. However, variations in pre-post TKR and THR changes in function and pain by obesity status remain to be examined. 

Methods: Pre- and 6 month post TKR data on physical function and pain were collected on 1,533 primary TKR and 1,118 primary THR patients between 5/2011 and 10/2012. Data included demographics, comorbidities, operative joint pain severity based on the Knee Injury/Hip Disability and Osteoarthritis Outcome Score (KOOS/HOOS), physical function (SF-36 PCS), mental health (SF-36 MCS), and musculoskeletal burden of illness.  Pre-post changes in PCS and pain were analyzed using descriptive statistics and linear mixed models that accounted for the clustering of patients within clinic. 

Results: Approximately 14% of TKR patients were under or normal weight (BMI<25), 33% overweight (BMI: 25.1-30), 29% obese (BMI: 30.1-35), 15% severely obese (BMI: 35.1-40) and 9% morbidly obese (BMI>40). Patients had average age of 67 years, included 61% women and 93% whites. Patients with greater level of obesity had lower PCS at baseline (p<0.001) and 6 month (p<0.001). However, pre-TKR to 6 month post-TKR change in  PCS  did not differ by level of obesity (p=0.554), and had an overall mean (SE) of 9.7 (0.23). Patients with greater levels of obesity had worse pain scores at baseline (p<0.001) but greater change in pain between pre-TKR and  6 months post-TKR (p=0.001). As a result, average pain scores at 6 months were similar across  levels of obesity (p=0.150), and had an overall mean (SE) of 84.9 (0.40).

Approximately 27% THR patients were under/normal weight (BMI<25), 38% overweight (BMI: 25.1-30), 23% obese (BMI: 30.1-35), 9% severely obese (BMI: 35.1-40) and 4% morbidly obese (BMI>40). Patients had average age of 66 years, included 62% women and 95% whites. Greater level of obesity was associated with lower PCS at baseline (p<0.001) and 6 month (p<0.001). Mean change in pre-to-six month PCS was greater in patients with BMI <35 when compared to BMI>35 ( 14 vs. 11.5)   Greater level of obesity was associated with a poorer baseline pain score (p<0.001) but larger change in post-op pain at (p=0.001). At 6 months, pain scores did not differ by level of obesity (p=0.068) with a mean score greater than 90.

Conclusion: At 6 months after TKR, severely obese patients (BMI>35) reported improvements in pain and function equal to or greater than patients with BMI<35.  At 6 months after THR, all patients reported significant functional gains although patients with BMI>35 had lower mean functional gain than those with BMI<35. All patients reported excellent pain relief.

Disclosure:

W. Li,

AHRQ,

2;

L. R. Harrold,

CORRONA, Inc.,

5;

J. Allison,

AHRQ,

2;

C. Lewis,
None;

T. Bowen,
None;

P. D. Franklin,

NIAMS-NIH, NLM-NIH, AHRQ, Zimmer, ,

2;

D. Ayers,

AHRQ, Zimmer,

2.

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