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: Ankle Arthroplasty in the Morbidly Obese Patient

: Ankle Arthroplasty in the Morbidly Obese Patient. Keith L. Wapner M.D., University of Pennsylvania Department of Orthopedic Surgery. Disclosures. Consultant –Stryker, Cartiva Institutional Support –Komfort Kare. Define Obesity. o·be·si·ty / ōˈbēsədē / noun

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: Ankle Arthroplasty in the Morbidly Obese Patient

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  1. : Ankle Arthroplasty in the Morbidly Obese Patient Keith L. Wapner M.D., University of Pennsylvania Department of Orthopedic Surgery

  2. Disclosures • Consultant –Stryker, Cartiva • Institutional Support –Komfort Kare

  3. Define Obesity o·be·si·ty /ōˈbēsədē/ noun • the condition of being grossly fat or overweight.

  4. Define Obesity Ideal weight for TAA 250lbs (113 kg) ? 6’5” (1.98cm) at 250lbs (113 kg) 5’5” (1.68cm) at 250lbs (113 kg) BMI

  5. Define Obesity • Height • Influences the pressure across the ankle joint

  6. Define Obesity • BMI

  7. Life Style • Occupation • Laborer • Office work

  8. Life Style • Retired • Couch Potato

  9. Define Obesity • Walmart! • BMI

  10. Ankle Arthroplasty in the Morbidly Obese Patient The effect of body mass index on outcomes after total ankle replacement. Baker JF1, Perera A, Lui DF, Stephens MM.Ir Med J. 2009 Jun;102(6):188-90 No association between high BMI reduced outcomes need for secondary surgery No significant change in BMI after surgery.

  11. Total ankle replacement in obese patients: component stability, weight change, and functional outcome in 118 consecutive patients. Barg A, Knupp M, Anderson AE, HintermannB.Foot Ankle Int. 2011 Oct;32(10):925-32. TAR gives significant pain relief and functional improvement Survivorship of the prosthesis components was comparable to the results obtained in non-obese patients Mean followup 67.7 +/- 27.0 months (29 to 126) Ankle Arthroplasty in the Morbidly Obese Patient

  12. Total ankle replacement in obese patients: component stability, weight change, and functional outcome in 118 consecutive patients. Barg A, Knupp M, Anderson AE, HintermannB.Foot Ankle Int. 2011 Oct;32(10):925-32. BMI 32.9 (30 – 40) at surgery BMI 32.2 (28.6 – 40.50) at 2 years 6 year survivorship 93% Ankle Arthroplasty in the Morbidly Obese Patient

  13. Ankle Arthroplasty in the Morbidly Obese Patient Mean BMI of overweight and obese patients does not decrease after successful ankle reconstruction Penner MJ1, Pakzad H, Younger A, Wing KJ. J Bone Joint Surg Am. 2012 May 2;94(9) 145 overweight (BMI = 25.1 to 29.9 kg/m2) or obese (BMI > 30 kg/m2) No significant change in mean BMI, compared with the preoperative BMI, over 5 years Significant improvement in the AOS and Short Form-36 (SF-36) Physical Component Summary scores at all time points

  14. Ankle Arthroplasty in the Morbidly Obese Patient Mean BMI of overweight and obese patients does not decrease after successful ankle reconstruction Penner MJ1, Pakzad H, Younger A, Wing KJ. J Bone Joint Surg Am. 2012 May 2;94(9) Obesity is likely attributable to factors other than limited mobility caused by ankle arthritis

  15. Ankle Arthroplasty in the Morbidly Obese Patient The variables of obesity, Short Form-36 Mental Component Summary score, surgery day of the week, and surgical duration were not associated with length of stay Factors associated with longer length of hospital stay after primary elective ankle surgery for end-stage ankle arthritis Pakzad H1, Thevendran G2, Penner MJ3, Qian H4, Younger A J Bone Joint Surg Am. 2014 Jan 1;96(1):32-9

  16. Ankle Arthroplasty in the Morbidly Obese Patient Obese (BMI>30) TAA patients had a significantly increased risk of 90-day major, minor, local, systemic, venous thromboembolic, infectious, and medical complications compared with non-obese patients  The incidence of revision TAA was also significantly higher in obese patients Obesity Is Associated With Increased Complications After Operative Management of End-Stage Ankle Arthritis Werner BC1, Burrus MT2, Looney AM2, Park JS2, Perumal V2, Cooper MT Foot Ankle Int. 2015 Aug;36(8):863-70

  17. Ankle Arthroplasty in the Morbidly Obese Patient The impact of obesity on the outcome of total ankle replacement Bouchard M1, Amin A2, Pinsker E1, Khan R1, Deda E1, Daniels TR J Bone Joint Surg Am. 2015 Jun 3;97(11):904-10 39 morbidly obese BMI >40 kg/m Obese patients had increased disability and worse function preoperatively TAR significantly and similarly improved pain and disability scores in both obese and non-obese patients With no significant difference in the proportion of complications

  18. Ankle Arthroplasty in the Morbidly Obese Patient 266 patients with a body mass index (BMI) <30 (control), 116 with a BMI between 30 and 35 (Obese I), and 73 with a BMI >35 (Obese II) Obese I, Obese II, and control groups functional outcome scores 1 year postoperatively were significantly improved Most recent follow-up, Obese II patients had lower FAOS Pain and SF-36 scores and higher FADI and SMFA Functional scores The Effect of Obesity on Functional Outcomes and Complications in Total Ankle Arthroplasty Gross CE, Lampley A, Green CL, DeOrio JK, Easley M, Adams S, Nunley JA

  19. Ankle Arthroplasty in the Morbidly Obese Patient Effect of Obesity on Total Ankle Arthroplasty: A Systematic Review of Postoperative Complications Requiring Surgical Revision Sansosti LE, Van JC, Meyr AJ J Foot Ankle Surg. 2018 Mar - Apr;57(2):353-356 Defined cohort with a body mass index of ≥30 kg/m 400 implants analyzed ≥71 (17.8%) developed a complication requiring a revisional surgical procedure

  20. Ankle Arthroplasty in the Morbidly Obese Patient Reasonable pain relief Possibly higher complication rate Improved but still compromised functional level If they start obese they stay obese

  21. Ankle Arthroplasty in the Morbidly Obese Patient • Adjacent joint arthritis • Adjacent joint motion • Contralateral ankle • Hip and knee • Degree of deformity • Adjacent joint motion

  22. Why Ankle Fusions?

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