r e v b r a s o r t o p . 2014;49(5):473–476
w w w . r b o . o r g . b r
Original
Article
Do
patients
lose
weight
after
total
hip
arthroplasty?
夽
,
夽夽
Carlos
Roberto
Schwartsmann
a,b,∗,
Felipe
Ribeiro
Ledur
b,
Leandro
de
Freitas
Spinelli
c,
Bruno
Lorandos
Germani
d,
Leonardo
Carbonera
Boschin
c,
Ramiro
Zilles
Gonc¸alves
c,
Anthony
Kerbes
Yépez
c,
Marco
Tonding
Ferreira
b,
Marcelo
Faria
Silva
eaUniversidadeFederaldeCiênciasdaSaúdedePortoAlegre(UFCSPA),PortoAlegre,RS,Brazil
bOrthopedicsandTraumatologyService,SantaCasadePortoAlegre,PortoAlegre,RS,Brazil
cHipSurgeryGroup,OrthopedicsandTraumatologyService,SantaCasadePortoAlegre,PortoAlegre,RS,Brazil
dSchoolofMedicine,UniversidadeFederaldeCiênciasdaSaúdedePortoAlegre(UFCSPA),PortoAlegre,RS,Brazil
eDepartmentofPhysiotherapy,UniversidadeFederaldeCiênciasdaSaúdedePortoAlegre(UFCSPA),PortoAlegre,RS,Brazil
a
r
t
i
c
l
e
i
n
f
o
Articlehistory:
Received26June2013 Accepted10September2013 Availableonline28August2014
Keywords:
Weightloss Bodymassindex Hiparthroplasty Hip/surgery
a
b
s
t
r
a
c
t
Objective:Toinvestigatetheeffectoftotalhiparthroplasty(THA)onbodymassindex(BMI), frombeforetoaftertheoperation.
Methods:100patientswhounderwentTHAwereretrospectivelyanalyzed.Theywere strat-ifiedaccordingtoBMI,asproposedbytheWorldHealthOrganization(WHO).
Results:Therewere48malepatientsand52femalepatients.Theirmeanagewas63.8±13.5 years. Themean follow-up was24.6±0.6months.The men had a mean preoperative BMIof28.4± 3.6kg/m2andthewomen,27.5± 5.0kg/m2.ThemeanpostoperativeBMIwas
28.9± 0.7kg/m2forthemenand27.8± 0.7kg/m2forthewomen.Therewasageneralmean
increaseinBMIof0.4kg/m2.TheBMIincreasedbothinpatientswithnormalweightand
inthosewhowereoverweight,butitdecreasedslightlyinpatientswhowereobese.BMI remainedunchangedinthemajorityofthepatients(73%).
Conclusion: TheimprovementinmobilityachievedthroughTHAdidnotpromoteany reduc-tioninanthropometricmeasurementsinthemajorityofthepatients.
©2014SociedadeBrasileiradeOrtopediaeTraumatologia.PublishedbyElsevierEditora Ltda.Allrightsreserved.
Os
pacientes
emagrecem
após
artroplastia
total
do
quadril?
Palavras-chave:
Perdadepeso
r
e
s
u
m
o
Objetivo:Investigaroefeitodaartroplastiatotaldoquadril(ATQ)noíndicedemassacorporal emrelac¸ãoaopréeaopós-operatório.
夽
Pleasecitethisarticleas:SchwartsmannCR,LedurFR,SpinelliLF,GermaniBL,BoschinLC,Gonc¸alvesRZetal.Ospacientesemagrecem apósartroplastiatotaldoquadril?RevBrasOrtop.2014;49(5):473–6.
夽夽
WorkdevelopedattheOrthopedicsandTraumatologyService,SantaCasadeMisericórdia,PortoAlegre,RS,Brazil.
∗ Correspondingauthor.
E-mail:[email protected](C.R.Schwartsmann). http://dx.doi.org/10.1016/j.rboe.2014.08.007
474
rev bras ortop.2014;49(5):473–476Índicedemassacorporal Artroplastiadequadril Quadril/cirurgia
Métodos: Foram analisados retrospectivamente 100 pacientes submetidos à ATQ. Os pacientesforamestratificadospeloíndicedemassacorporal(IMC),conformepropostopela Organizac¸ãoMundialdeSaúde(OMS).
Resultados: Foramobservados48pacientesdosexomasculinoe52dofeminino.Amédiade idadefoide63,8±13,5anos.Oseguimentomédiofoide24,6±0,6meses.Oshomens apre-sentaramIMCpré-operatóriomédiode28,4± 3,6kg/m2easmulheres,de27,5 ± 5,0kg/m2.
OIMCmédiopós-operatóriofoi28,9± 0,7kg/m2paraoshomense27,8± 0,7kg/m2paraas
mulheres.OcorreuumamédiadeaumentogeraldoIMCem0,4kg/m2.OIMCaumentouem
pacientescompesonormalecomsobrepeso,masdiminuiulevementeempacientescom obesidade.Amaioriadospacientes(73%)permaneceucomoIMCinalterado.
Conclusão: AmelhoriadamobilidadeobtidacomaATQnãopromoveuumareduc¸ãodas medidasantropométricasnamaioriadospacientes.
©2014SociedadeBrasileiradeOrtopediaeTraumatologia.PublicadoporElsevier EditoraLtda.Todososdireitosreservados.
Introduction
Thepercentageofthe obese populationwithosteoarthritis
is growing within the worldwidepopulation. The demand
fortotal hip arthroplasty (THA) surgeryhas been continu-allyincreasing.Thereisevidencethat therelativeriskthat anindividual willneedtoundergo hip arthroplastyranges from1.92amongoverweightindividualsto8.56amongthose who are severely obese.1 Quality of life seems to worsen inobese patientsovertheyearsfollowingtheprocedure.2–4 Therefore,losingweightbeforeTHAsurgeryisimportantand greatlyencouraged,5giventhatahighbodymassindex(BMI)
has been shown to be a risk factor for worsening of hip
osteoarthrosis.6Inaddition,otherobjectivesofweight reduc-tionincludediminishingthesurgicalriskandincreasingthe longevityoftheimplant.
Patientsgenerallyrefertocoxarthrosispainasthe expla-nationfornotlosingweightduringtheperiodprecedingthe surgicalprocedure.Withinthiscontext,thereistheideathat weightlosswilltakeplacenaturallyaftersurgery,sincethe patientwillhavelesspainandfunctionallimitationandwill thereforebeabletodophysicalexercisemoreeasily.Inthis way,restorationofthepatient’sphysicalcapacityisoneofthe aimsofhiparthroplasty.7
Theobjectiveofthepresentstudywastoinvestigatethe effectofhiparthroplastysurgeryonbodymassindex,thus asking whether patients are able to lose weight after hip arthroplasty.
Patients
and
methods
Themedicalfilesof100patientswhounderwentTHAbetween
November2008andNovember2011wereretrospectively
ana-lyzed. Theinclusion criteriawere that thepatientsneeded tohavehad adiagnosisofhiposteoarthrosis,BMI≥20and
minimumpostoperativefollow-upof18months.Thosewith
incompleterecordsrelatingtodemographicdataoreitherof thetwoweightmeasurementtimes(beforetheoperationand atalaterpostoperativestage)wereexcluded.
Weightandheightweremeasuredonconventionaldigital
scales made by Urano,with a capacity of180kg and
divi-sionsof100g,whichalsohadameasuringtapeavailable.The
BMIwascalculatedusingtheformulaw/h2,inwhichwisthe patient’sweight(kg)andhishisheight(m).Thepatientswere stratifiedateachtimeaccordingtotheirBMI,asproposedby theWorldHealthOrganization(WHO),8inthefollowing man-ner:normalweight(BMI<25),overweight(BMIbetween25and 30)andobesity(BMI>30).
Descriptive statistics and frequency distributions were observed.Thegroupswerecorrelatedbymeansofthetor chi-squaretests,accordingtothevariableunderanalysis.p<0.05 wasconsideredtobestatisticallysignificant.95%confidence intervals(CI)wereused.Thedataanalysiswasdoneusingthe SPSSforWindowssoftware,v.14.
Results
There were 48 male patients (48%)and 52 female patients
(52%). Justbeforethe operation,the meanage ofthe sam-pled population was63.8 years(standard deviation:±13.5): 62.4±14.3 years for the men and 65.1±12.6 years for the women.Themeanlengthoffollow-upwas24.6±0.6months. Themeanweightamongthemalepatientswas84.5±11.5kg
and among the female patients, 72.6±13.9kg. The mean
height among the men was 1.72±0.07m and among the
women,1.62±0.06m.
Themean preoperativeBMIwas 28.0±0.6kg/m2. Atthe timeofdatagathering,29patientspresentednormalweight (BMI<25),42wereoverweight(BMI25–30)and29wereobese (BMI>30),ascanbeseeningreaterdetailinTable1.Themen’s meanpreoperativeBMIwas28.4±3.6kg/m2andthewomen’s was27.5±5.0kg/m2.
Thepostoperativeanalysisshowedthattherewasa ten-dencytowardweightdecreasein36patients(36%);15didnot presentanyweightchange(15%),but49gainedweight(49%). ThemeanpostoperativeBMIwas28.3kg/m2:28.9±0.7kg/m2 forthemenand27.8±0.7kg/m2forthewomen.Overall,there wasameanincreaseinBMIof0.4.
Table1alsoshowsthattheBMItendedtoincreaseamong patientswithnormalweightandamongoverweightpatients, butpresentedatendencytodiminishamongobesepatients.
However,thechangesinweightthatwereobserveddidnot
rev bras ortop.2014;49(5):473–476
475
Table1–BMIdistributionamongthepatientsevaluated.
BMI N MeanpreoperativeBMI MeanpostoperativeBMI MeanincreaseinBMI pvalue
Allthepatients 100 27.95±4.39 28.32±4.88 −0.37 0.568
20–24.9(normal) 28 23.36±1.43 22.91±1.40 0.45 0.245
25–29.9(overweight) 42 27.28±1.46 26.93±1.38 0.35 0.275
>30(obese) 29 33.37±3.27 33.36±3.48 0.01 0.986
Men 48 28.44±3.62 28.93±4.59 −0.49 0.568
Women 52 27.49±4.98 27.77±5.11 −0.28 0.782
Table 2 presents the preoperative distribution of the patientsaccordingtoBMIgroupandtheirmigrationafterthe operation,inamorespecificmannerpergroup.Increasesin BMIwereobservedinnine patientsinthe groupwith nor-malBMI;11patientswentfromoverweighttoobeseandthree patientsintheobesegroupshowedreductions:onetonormal BMIandtwotooverweight.However,73patients(73%)inthe
sampleremainedwithunchangedBMI.
Table3showsthe generalnumber ofpatientsaccording topreandpostoperativeBMI.AsalsoshowninTable2,itwas observedthattherewasatendencyforpatientswithlowerBMI tomigratetohigherBMI.Patientsinthegroupwithnormal BMImigratedtotheoverweightgroup,whilepatientsinthis groupmigratedtotheobesegroupaftertheoperation.Overall, thepatients’meanweightincreased.
Discussion
BMI is frequently used as a tool for assessing patients’
nutritionalstatusandalsoasameansofevaluatingobesity in epidemiological studies.9 WHO8 has suggested that the idealBMImeasurementshouldbebetween20and25kg/m2.
Table2–SpecificchangesinBMIaccordingtogroup, frombeforetoaftertheoperation.
PreoperativeBMI PostoperativeBMI
Normal(20–24.9): 29patientsinitially
Normal(unaltered):21 patientsa
Overweight:7patients Obese:1patient Overweight(25–29.9):
42patientsinitially
Overweight(unaltered):26 patientsa
Normal:5patients Obese:11patients Obese(>30):
29patientsinitially
Obese(unaltered):26patientsa
Normal:1patient Overweight:2patients
a 73patientscontinuedtopresentthesameweight,unaltered,
withintheirBMIcategory.
Table3–PatientdistributionaccordingtoBMIfrom beforetoaftertheoperation.
BMI 20–24.9
(normal)
25–29.9 (overweight)
>30(obese)
Beforeoperation 29 42 29
Afteroperation 27 35 38
In relation to higher BMI among patients who are candi-datesforhiparthroplasty,somestudieshavecorrelatedhip osteoarthrosiswithobesity.10,11Ithasbeenobservedthatthe greatmajorityofthepatientswhoarecandidatesforTHAare outsideofthisidealweightrange.
Some authors have shown that postoperative weight
changes occuramongpatientsundergoingvarious typesof
arthroplasty, including of the knee and hip.12–15 Aderinto etal.16suggestedthatweightgainssubsequenttoTHAwere common,despitethefunctionalimprovementfromthe proce-dure,butthattheweightgainwouldbegreateramongobese individuals.MiddletonandBoardman15reportedthat, inde-pendentofthepreoperativeBMI,weightreductionwouldnot occur afterarthroplasty. In the present study,weobserved thatthemajorityofthepatientsdidnotpresent postopera-tivechangesinBMI.Inageneralmanner, increasesinBMI
occurred amongpatients withnormalBMIandoverweight,
butBMIdecreasedinpatientswhopresentedestablished obe-sity.Itshouldbeemphasizedthatthevaluesobtainedwere trendsandthattheywerenotstatisticallysignificant(p>0.05). ItcouldalsobeseenthatthetendencytowardincreasedBMI
occurredbothinmenandinwomen.
Dowseyand Liew13analyzedweightchangesamong529
patientswhounderwentTHA,after12monthsoffollow-up, andobservedthatweightreductionsonlyoccurredin12.6% oftheindividuals.Abu-RajabandFindlay14reportedthat30% ofthepatientspresentedweightdecreasesovera12-month period.Jainetal.17 retrospectivelyreviewed78patientsand observedtheirweightandheightafterTHA.Theyfoundthat thepatients’BMIincreasedaftertheoperation.Inageneral manner,thepresentstudycorroboratessomeofthefindings oftheseauthors.
Nonetheless,thereisstillsomecontroversyinthecurrent literature.Somestudieshaveshownresultsthatfavorweight lossafterTHA.18Forexample,Paansetal.18evaluated post-operativeweightandBMIafter1.0and4.5yearsoffollow-up andobservedthatthereweresignificantreductionsinthese
measurements. Onthe other hand,ithasto benotedthat
thesestudieswereconductedinseveralcountries,with dif-ferent ethnic groupswithavarietyofdietary andphysical activity habits. In the presentstudy, withinBrazilian reali-ties,only8%ofthepatientsreducedtheirweight,while19% gainedweightafterthehiparthroplastyoperation.Basedon
these results,it canberecommended thatpatients should
decrease theirweightbeforetheoperationandalso dimin-ishtherisksrelatingtothetransoperativeandpostoperative periods.IndependentofweightandBMIpriortotheprocedure,
the improvementinmobilityachieved throughTHA inthe
476
rev bras ortop.2014;49(5):473–476thatmostofthemcontinuedtopresentthesameBMIasbefore theoperation(73%).
Werecognizethattherearesomelimitationstothepresent
study. Among these is the lack of observation of dietary
habits,physicalactivitylevels,ethnicprofile,culturalorigin, socioeconomicprofile,schoolinglevel,etc.However,thisstudy indicatestheimportanceofdiminishingBMIbeforethe
oper-ation, because there is a general tendency toward weight
increases.ThepatientswhounderwentTHAdidnotbecome
responsivetotheappealstolose weightbeforethesurgical procedure,whichhadbeenemphasizedandextensively dis-cussedwithourteambeforetheoperation,andsomepatients evenincreasedinweight.
Conclusion
THAsurgerydidnotcontributetowarddiminishingtheBMIof thepatientsoperated.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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