Body mass index as a predictor of outcome in total knee replacement

The clinical and radiographic outcomes of 326 total knee replacements (TKR) in 285 osteoarthritic patients with body mass index (BMI) greater than 30 kg/m(2) were compared with the results of a matched group of 425 TKR in 371 patients with BMI less than 30 kg/m(2). At an average follow-up of 75.9 (4 8-144) months the Knee Society score (KSS) in the obese patients had increa sed by 41.9 points, and the joint score by 43.7. In the non-obese group the KSS rose by 40.2 points and the joint score by 42.6 points. Although patie nts with BMI greater than 40 kg/m(2) achieved a lower final KSS the,absolut e improvement' appeared to be independent of BMI. Of the obese patient grou p 4.9% underwent a revision of their TKR, compared with 3.1% of the non-obe se group. Although linear osteolysis (radiolucency) rates were comparable, focal osteolysis rates were 5 times those of control subjects when the BMI exceeded 40 kg/m(2). Ten-year survivorship figures were similar for both ob ese and non-obese patients.