Issues affecting complications after knee or hip arthroplasty

This thesis addresses two major public health concerns - obesity and opioid dependence - in patients undergoing the costliest surgical intervention in societal terms (hip and knee arthroplasty). By tackling these pre-arthroplasty issues, this thesis aims to reduce the burden of arthroplasty surgery and cut down on episode-of-care costs associated with such surgical care. Chapter 2’s systematic review and meta-analysis assessed the low-inflammatory diet as an intervention for patients who have arthritis. It found that low inflammatory diet/supplements (compared to usual diet) are associated with improved inflammatory biomarkers and greater weight loss in those who suffer from Osteoarthritis or Rheumatoid Arthritis. To assess such benefits, Chapter 3’s prospective pilot study evaluated the feasibility of implementing a novel anti-inflammatory diet in obese pre-arthroplasty patients for weight management. The pilot study found that using a dietitian-led low-inflammatory diet in obese pre-arthroplasty patients was not feasible. Furthermore, the low-inflammatory diet provided very modest weight loss compared to usual care. Chapter 4’s retrospective analysis of data from NSW public hospitals assessed the association between pre-operative opioid use and complications following knee and hip arthroplasty. The retrospective study found that 30% of patients were using prescribed opioids before primary hip or knee arthroplasty, and pre-arthroplasty opioid use was not associated with post-operative adverse events or patient-reported function, pain or global perceived improvement up to six months post-operatively (contrary to other published studies). Chapter 5’s qualitative study assessed the perspectives of pre-arthroplasty and chronic pain patients utilising opioids and their willingness for opioid tapering. Both groups shared similar perspectives regarding their acceptability of opioid tapering, management of pain and stakeholders that need addressing when considering changes in pain management and opioid tapering. Interestingly, chronic pain patients had ‘hope’ to taper opioids, whilst arthroplasty was not an impetus for opioid tapering.

Grantor dc:publisher

UNSW, Sydney

Year dc:date

2025

Author dc:creator

• Genel, Furkan ; https://orcid.org/0000-0002-0976-1469

• Orthopaedics
• Orthopaedic Surgery
• Total Knee Arthroplasty
• Total Hip Arthroplasty
• Obesity
• Low Inflammatory Diet
• Opioid Dependence
• Opioid Tapering
• anzsrc-for: 320216 Orthopaedics
• anzsrc-for: 3210 Nutrition and dietetics
• anzsrc-for: 320226 Surgery

Statement dc:rights

• embargoed access
• CC BY 4.0

Licence

• http://purl.org/coar/access_right/c_f1cf
• https://creativecommons.org/licenses/by/4.0/

Language dc:language

en

Identifier

https://doi.org/10.26190/unsworks/31200

OAI identifier oai:identifier

oai:unsworks.library.unsw.edu.au:1959.4/105096