Obesity has a negative impact on clinical outcome after total knee arthroplasty.

BACKGROUND AND AIMS: Obesity has been linked to the development of osteoarthritis of the knee and since the incidence of obesity is increasing, the need for total knee arthroplasty (TKA) is likely to increase. Conflicting findings have been reported concerning the relationship between obesity and TKA. It has been shown in several studies, that obese patients have poorer clinical results after operation. On the other hand it has also been reported similar results for obese and non-obese patients. The purpose of this study was to analyze clinically and radiologically the results of total knee artrhoplasty in obese patients. MATERIAL AND METHODS: The study consisted of 48 patients who had a TKA. The patients were divided in two groups according their body mass index. Patients of BMI over 30 were regarded as obese. RESULTS: The obese patients had poorer clinical success at the final follow-up, their WOMAC scores were significantly higher compared to non-obese (pain 20.7 vs. 11.6; p = 0.021, stiffness 26.9 vs. 13.4; p = 0.006, physical function 26.5 vs. 14.4; p = 0.003). Differences were also found in the Knee (KS) and Function (FS) scores and a long-term postoperative ROM and (KS: 83.6 vs. 88.9; p = 0.01, FS: 63.6/76.3; p = 0.051, ROM: 104.6 vs. 109.6; p = 0.016). Non-obese patients reached better percentage improvement in the KSS compared to obese patients (KS change + 194.5% vs. + 59.5%, p = 0.03; FS change + 51.5% vs. + 14.9%, p = 0.19). CONCLUSIONS: Obesity has a negative impact on the outcome of TKA, assessed by patients' clinical function and satisfaction level.

Obesity may impair the early outcome of total knee arthroplasty.

BACKGROUND AND AIMS: Obesity has been linked to the development of osteoarthritis of the knee and increases the probability to fall into total knee arthroplasty. In this study we compared short-term outcome of total knee arthroplasty (TKA) in non-obese and obese patients. MATERIAL AND METHODS: A total of 100 patients underwent TKA between October 2006 and March 2007. They were divided into two groups based on the body mass index: 52 of the patients were obese (BMI = 30 kg/m2) and 48 non-obese (BMI < 30 kg/m2). The short-term out-come was studied using clinical, functional and radiological analysis. The mean of the follow-up period was 3 months. RESULTS: There were five complications (2 wound infections, phlebitis, nerve injury and massive edema) in obese patients group compared with no complications in non-obese (p = 0.028). The obese patients had also worse postoperative range of motion (110 degrees vs.118 degrees , p = 0.001) than non-obese and the number of technical errors was 17 in obese and 5 in non-obese group, respectively (p = 0.007). CONCLUSIONS: We suggest that obesity may impair the early outcome of total knee arthroplasty and obese patients should be informed about the increased risk of complications related to TKA. Key words: Total knee arthroplasty; body mass index; obesity; complications; range of motion; mechanical axis.

Cord compression may rapidly influence the expression of placental angiogenic genes in pre-eclampsia.

Gene expression studies have demonstrated the altered expression level of placental angiogenesis related genes in severe pre-eclampsia (PE). In cord compression, the transportation of oxygen from the placenta to the fetus is blocked, and it is speculated that during blockade the originally hypoxic placenta may become hyperoxic. We compared the placental gene expression profiles of one pre-eclamptic patient with cord compression (the index patient) to the profiles of patients with PE and those of normal pregnancy controls (including one woman with cord compression). The gene expression of the cord compression PE patient resembled that observed in the normal pregnancies. We hypothesize that umbilical blockade may in a short period of time lead to placental hyperoxia, which in turn has an effect on angiogenic gene expression profile.

Evaluation of factor V Leiden, prothrombin and methylenetetrahydrofolate reductase gene mutations in patients with severe pregnancy complications in northern Finland.

BACKGROUND: Thrombosis in placenta may lead to severe pregnancy complications. Most important inherited thrombophilias are factor V Leiden mutation, prothrombin mutation, and methylenetetrahydrofolate reductase mutation. The aim of our research was to evaluate the prevalence of inherited thrombophilias in severe pregnancy complications and in normal pregnancies. MATERIAL AND METHODS: The study subjects with severe preeclampsia, intrauterine growth restriction, placental abruption or fetal death were collected during the period 1999-2004 from Oulu University Hospital. We also collected during the same period voluntary parturients with normal pregnancy outcome as the control group. FVL, FII, and MTHFR gene mutations of the patients and controls were analyzed. RESULTS: We found a significant difference in the prevalence of FVL mutation between the groups. There were 9.5% FVL mutations in the study group compared to 1.8% in the control group; the observed difference between prevalences was 7.7% (95% CI 2.0-13.4). No statistical difference was found in the FII or MTHFR mutations between the groups. All FV and FII mutations were heterozygous and all the MTHFR mutations homozygous. CONCLUSION: Women with thrombophilia have a risk for severe pregnancy complications. Randomized controlled trials are needed to assess the influence of low-molecular-weight heparin in pregnant women with thrombophilia.