Understanding patient factors associated with weight gain and weight loss after knee or hip arthroplasty: An opportunity to increase the value of this expensive intervention

A/Prof Justine Naylor1,2,5, Dr Kathryn Mills3, Ms Natasha Pocovi3, A/Prof Sarah Dennis1,4,5, Ms Danella Hackett1, Dr Leanne Hassett1,4, Dr Bernadette Brady1, Ms Adriane Lewin2, Dr Sam Adie2, Dr Wei Xuan2,5

1SWSLHD, Liverpool Bc, Australia, 2SWS Clinical School UNSW, Liverpool BC, Australia, 3Macquarie University, Ryde, Australia, 4University of Sydney, Lidcombe, Australia, 5Ingham Institute for Applied Medical Research, Liverpool, Australia

Following total knee or total hip arthroplasty (TKA, THA), up to 31% of recipients experience significant weight gain while up to 14% experience significant weight loss. Factors associated with significant weight change (≥ 5%) have not been comprehensively explored. This study aimed to identify pre- and post-surgical (including current) patient factors associated with significant weight change three years after surgery.

A pre-existing nationally-acquired cohort who underwent TKA or THA for osteoarthritis participated in 3-year telephone follow-up. Updated weight, comorbidity, and complication data were collected along with participation in regular physical activity, ongoing index joint problems, and other patient-reported outcomes. These data, along with body mass index (BMI) pre-surgery and post-surgery rehabilitation received, were incorporated into two multivariable logistic regression models to determine the factors associated with ≥ 5% weight gain and ≥ 5% loss at 3-years post-surgery.

73.4% (1289/1757) participated in the follow-up; 1191 (n = 663 TKA) provided updated weight data. Patterns of weight change were similar for both surgeries (TKA: 16.1% gained ≥ 5%, 19.6% lost ≥ 5%; THA: 15.8% gained ≥ 5%, 17.8% lost ≥ 5%). In multivariable modelling, younger age and lower pre-surgery BMI were significantly associated with weight gain; female gender and an absence of ongoing index joint issues were associated with weight loss.

Discussion & Conclusion:
Different mechanisms are likely associated with significant weight gain or loss at 3-years post-surgery. Cogent weight management entails consideration of both outcomes. Allied health clinicians have a role in promoting weight management as part of post-surgery rehabilitation as well as during the prehabilitation phase. Better weight management should lead to improved patient outcomes and ultimately better value healthcare from the perspective of all stakeholders.


A/Prof Justine Naylor is a physiotherapist and senior principal research fellow in Orthopaedics at SWSLHD, and a Conjoint A/Prof at UNSW. She has published widely in the orthopaedic literature especially in the arthroplasty field. She has research interests directed at improving the value of care provided for arthroplasty patients and improving outcomes following surgery.

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