Can obesity and physical activity predict outcomes of elective knee or hip surgery due to osteoarthritis? A meta-analysis of cohort studies.

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obesity 19 Title: BMJ OpenCan obesity and physical activity predict outcomes of elective knee or hip surgery due to osteoarthritis? A meta-analysis
obesity 455 2/2018AbstractObjectiveThe aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing
obesity 937 were included in the review. To be included, studies needed to have assessed the association between obesity or physical activity participation measured at baseline and clinical outcomes (ie, pain, disability
obesity 1194 arthroplasty.Data extractionTwo independent reviewers extracted data on pain, disability, quality of life, obesity , physical activity and any postsurgical complications.Results62 full papers were included in this systematic
obesity 2115 0.59; P<0.001), and knee arthroplasty (OR 0.42; 95% CI 0.23 to 0.78; P=0.006).ConclusionsPresurgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability
obesity 4599 breast and colon cancers and decreased life expectancy.[8] Although there is evidence for the role of obesity and physical inactivity in health conditions and quality of life in general,[9] the actual impact of
obesity 5165 arthroplasty[16] or have excluded pain outcomes.[13] No meta-analyses have been performed considering obesity and physical activity as predictors of surgical outcomes in terms of pain, disability, quality of life
obesity 5362 quality of life and complications after hip or knee arthroplasty for end-stage OA.Identifying whether obesity and physical activity participation predict surgical outcomes in patients with knee and hip OA will
obesity 5661 treatment approach. We have conducted a meta-analysis of cohort studies aiming to quantify the role of obesity and physical activity participation as predictors of clinical outcomes in terms of pain, disability,
obesity 6351 Web of Science. We used a combination of relevant keywords to construct the search strategy including obesity , physical activity, knee OA, hip OA, arthroplasty and elective surgery (online supplementary appendix
obesity 7095 language.10.1136/bmjopen-2017-017689.supp1Supplementary file 1Study selectionWe included only longitudinal studies assessing the role of obesity or physical activity participation on the clinical outcomes following partial or total hip arthroplasty
obesity 12224 possible, different analyses were performed for knee and hip arthroplasty and also for different levels of obesity (ie, obesity and morbid obesity). When means and SD of outcomes of interest were presented for multiple
obesity 12237 analyses were performed for knee and hip arthroplasty and also for different levels of obesity (ie, obesity and morbid obesity). When means and SD of outcomes of interest were presented for multiple predictor
obesity 12256 performed for knee and hip arthroplasty and also for different levels of obesity (ie, obesity and morbid obesity ). When means and SD of outcomes of interest were presented for multiple predictor groups in the same
obesity 23820 fractional polynomial analysis of pain scores evolution over time after knee surgeries.Association between obesity and postsurgical pain outcomesFourteen studies investigated the association between obesity and pain
obesity 23912 between obesity and postsurgical pain outcomesFourteen studies investigated the association between obesity and pain intensity in a total of 5687 patients after hip or knee arthroplasty. Seven of the 14 studies
obesity 25628 groups.Table 2Results of individual studies on the association between postsurgical pain and baseline obesity Obesity versus painAuthor, yearBMI: mean (SD)MeasureResultsKnee Davis et al, 2011[38]NAHOOS/KOOSAfter
obesity 27030 analogue scale; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.Association between obesity and postsurgical disability outcomesThe impact of obesity on disability was investigated by 32 studies
obesity 27088 Osteoarthritis Index.Association between obesity and postsurgical disability outcomesThe impact of obesity on disability was investigated by 32 studies which compared postsurgery disability scores in 35 286
obesity 28847 groups.Table 3Results of individual studies on the association between postsurgical disability and baseline obesity Obesity versus disabilityAuthor, yearBMI: mean (SD)MeasureResultsKnee Davis et al, 2011[38]NAWOMAC/KOOSAfter
obesity 31597 arthroplasty; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.Association between obesity and postsurgical complicationsThe association between obesity and complications after joint arthroplasty
obesity 31659 Osteoarthritis Index.Association between obesity and postsurgical complicationsThe association between obesity and complications after joint arthroplasty was assessed by 40 studies including a total of 245 433
obesity 32607 0.66; 95% CI 0.34 to 1.28; P=0.217) (figure 5).Figure 5Pooled association between complications and obesity at short-term and long-term follow-ups. Results from meta-analysis of included studies presented as
obesity 33631 non-obese participants were compared.Figure 6Pooled association between postsurgical infections and obesity for hip surgery. Results from meta-analysis of included studies presented as incidence of infections
obesity 34473 are presented in table 4.Table 4Results of individual studies investigating the association between obesity and postsurgical complicationsObesity versus complicationsAuthor, yearBMI: mean (SD)MeasureResultsOllivier et al,
obesity 37819 in both pain and disability after knee and hip arthroplasty when compared with obese patients, where obesity has been defined as having a BMI of 30 kg/m2 or over. These differences seemed to be more accentuated
obesity 38221 dislocation, DVT and infection especially following hip arthroplasty. Our analyses also demonstrate that obesity is a reliable predictor of complications after THA and TKA, in the short term after the procedure and
obesity 39459 in our review, given we have only included data from cohort studies that have assessed the role of obesity or physical activity participation on surgical outcomes.Strengths and weaknesses in relation to other
obesity 39688 particularly any differences in resultsOur meta-analysis results regarding the association between obesity and postsurgical complications found that obese patients present higher complication rates than non-obese
obesity 40015 Samson et al[15] and Liu et al.[16] Our meta-analysis results regarding the association between obesity and postsurgery disability also agreed with the findings of Buirs et al[13] and Samson et al,[15] which
obesity 40138 disability also agreed with the findings of Buirs et al[13] and Samson et al,[15] which found that obesity (defined as having BMI over 30 kg/m2) was associated with worst postsurgical functional score. The
obesity 40331 functional score. The only previous review which has performed a meta-analysis on the association between obesity and postarthroplasty pain or disability limited its inclusion criteria to hip joint.[16] That review
obesity 40509 to hip joint.[16] That review included a total of 15 studies in their meta-analysis and found that obesity increases the risk of postsurgical complications (RR 1.68; 95% CI 1.23 to 2.30; P=0.0004) and is associated
obesity 40878 participants in the qualitative analysis, 16 in the meta-analyses, and confirms past findings that obesity is associated with worse outcomes in terms of disability and complications, and pain at both short-term
obesity 41288 patients with OA. Although those authors included 35 studies, only five studies investigated the effect of obesity on postsurgical pain, disability and quality of life.[14] No meta-analysis was performed.Implications
obesity 43887 across studies.Between-study heterogeneity has also been observed in some of the pooled analysis for obesity presented in this review. A potential source of between-study heterogeneity includes the variability
obesity 44017 review. A potential source of between-study heterogeneity includes the variability in the definition of obesity categories across studies. Although obesity was assessed using BMI scores in all studies, some studies
obesity 44061 heterogeneity includes the variability in the definition of obesity categories across studies. Although obesity was assessed using BMI scores in all studies, some studies have used only two obesity groups (ie, obese
obesity 44147 studies. Although obesity was assessed using BMI scores in all studies, some studies have used only two obesity groups (ie, obese or non-obese) while others used several categories including underweight, normal or
obesity 44549 procedures used across studies. For instance, in the pooled analysis of risk of postsurgical DVT and obesity , while Kandil et al[54] performed unicompartmental knee arthroplasties, Friedman et al[42] performed

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