• Chad D Watts, Eric R Wagner, Matthew T Houdek, Douglas R Osmon, Arlen D Hanssen, David G Lewallen, and Tad M Mabry.
• Departments of Orthopedic Surgery (C.D.W., E.R.W., M.T.H., A.D.H., D.G.L., and T.M.M.) and Internal Medicine, Division of Infectious Diseases (D.R.O.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for T.M. Mabry: mabry.tad@mayo.edu.
• J Bone Joint Surg Am. 2014 Sep 17;96(18):e154.

BackgroundObese patients have a higher risk of complications following primary total knee arthroplasty, including periprosthetic joint infection. However, there is a paucity of data concerning the efficacy of two-stage revision arthroplasty in obese patients.MethodsWe performed a two-to-one matched cohort study to compare the outcomes of thirty-seven morbidly obese patients (those with a body mass index of ≥ 40 kg/m(2)) who underwent two-stage revision total knee arthroplasty for periprosthetic joint infection following primary total knee arthroplasty with the outcomes of seventy-four non-obese patients (those with a body mass index of <30 kg/m(2)). Groups were matched by sex, age, and date of reimplantation. Outcomes included subsequent revision, reinfection, reoperation, and Knee Society pain and function scores. The minimum follow-up time was five years.ResultsMorbidly obese patients had a significantly increased risk for revision surgery (32% compared with 11%; p < 0.01), reinfection (22% compared with 4%; p < 0.01), and reoperation (51% compared with 16%; p < 0.01). Implant survival rates were 80% for the morbidly obese group and 97% for the non-obese group at five years and 55% for the morbidly obese group and 82% for the non-obese group at ten years. Knee Society pain scores improved significantly following surgery in both groups; the mean scores (and standard deviation) were 50 ± 5 points for the morbidly obese group and 55 ± 2 points for the non-obese group (p = 0.06) preoperatively, 74 ± 5 points for the morbidly obese group and 89 ± 2 points for the non-obese group (p < 0.0001) at two years, 72 ± 6 points for the morbidly obese group and 88 ± 3 points for the non-obese group (p < 0.0001) at five years, and 56 ± 9 points for the morbidly obese group and 84 ± 3 points for the non-obese group (p = 0.01) at ten years.ConclusionsMorbid obesity significantly increased the risk of subsequent revision, reoperation, and reinfection following two-stage revision total knee arthroplasty for infection. In addition, these patients had worse pain relief and overall function at intermediate-term clinical follow-up. Although two-stage revision should remain a standard treatment for chronic periprosthetic joint infection in morbidly obese patients, increased failure rates and poorer outcomes should be anticipated.Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

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