Investigating a problematic trilogy: osteoarthritis, obesity and knee or hip arthroplasty
The growing obesity epidemic is contributing to the development and progression of hip and knee osteoarthritis and subsequent demand for arthroplasty procedures. Concerningly, obesity is associated with certain postoperative complications resulting in health and financial burdens to the patient and healthcare system. Clinicians routinely recommend preoperative weight loss to mitigate obesity-related complications. While diet and physical activity are safer and more accessible than pharmacological methods and bariatric surgery, it is unknown whether diet-based preoperative weight loss improves postoperative outcomes in people with obesity awaiting total knee (TKA) and total hip arthroplasty (THA). This thesis investigated the effect of obesity and preoperative weight loss on postoperative complications and patient-reported outcomes measures (PROMs) and explored the experience of weight management among people awaiting TKA and THA. The first study systematically reviewed the effect of preoperative weight-loss diets on elective surgery outcomes. A pilot study examined an anti-inflammatory weight-loss diet for improving outcomes to 90 days after arthroplasty while a nested qualitative study explored barriers and enablers to weight loss in this culturally and socially diverse cohort. Patient-reported physical activity, step count trajectory and barriers and enablers to being physically active preoperatively were studied via a mixed methods study. Finally, a retrospective study investigated the association between preoperative body mass index (BMI) and weight loss, and outcomes to 6 months post-arthroplasty. Based on limited systematic review data, weight-loss diets before elective surgery do not reduce postoperative complications to 30 days or hospital length of stay (LOS). Due to the Covid-19 pandemic, the pilot study could not evaluate the effectiveness of the diet intervention for reducing postoperative complications. However, PROMs and LOS did not differ between groups. Weight loss was influenced by a person's beliefs, adaptability, ability to navigate healthcare, and sociocultural context. Overall, participants were less physically active before surgery. Physical capability, accessibility to exercise, sociocultural norms, self-efficacy and beliefs influenced physical activity levels. In people with obesity, neither preoperative BMI nor a 5% reduction in BMI pre-surgery were associated with fewer complications or better PROMs to six months post-arthroplasty.
Pavlovic, Natalie ; https://orcid.org/0000-0003-0086-7379
Obesity, Arthroplasty, Total Knee Arthroplasty, Total Hip Arthroplasty, Joint Replacement, Osteoarthritis, Weight loss diet, Preoperative weight loss, Weight management, Diet, Postoperative complication, Surgery, Postoperative outcome, Orthopaedics, Physical activity, Exercise, Body Mass Index, Patient reported outcome measures, anzsrc-for: 320216 Orthopaedics, anzsrc-for: 3210 Nutrition and dietetics
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