Archives of orthopaedic and trauma surgery · 2026
Recommendations of an international Delphi study group for total knee arthroplasty in obese patients.
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Rajgopal Ashok, Palanisami Dhanasekara Raja, Annapareddy Adarsh, Khan Moin, Easwaran Raju, Shyam Ashok, Sanghavi Sahil, Sancheti Parag
Аннотация
INTRODUCTION: Total knee arthroplasty (TKA) in obese patients poses multiple challenges and there is a lack of consensus on various aspects of TKA in this patient population. This study is a modified Delphi consensus study of international experts to provide recommendations on TKA in obese patients.
MATERIALS AND METHODS: The consensus statements were generated using an anonymized two-round modified Delphi questionnaire, sent to an international panel of 53 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics, with median as the measure of central tendency. Anonymized feedback was provided to all panellists based on responses from previous rounds to help generate the consensus.
RESULTS: 9 statements reached a consensus: WHO classification (87%), BMI cut-off for single-stage bilateral TKA (92%), use of tibial stem (84%), medial parapatellar approach (92%), same surgical approach as non-obese TKA (92%), inherent malnutrition (82%), higher risk of aseptic loosening in BMI class 3 (81%), need for time interval between bilateral TKA (88%), and consensus against leaving the knee in slight flexion (82%). The panel was unable to reach a consensus on 17 statements.
CONCLUSION: This indicates lack of consensus on a majority of issues among experts and further research is required in this field to address evidence gaps, so we can improve our management of this increasing cohort of patients undergoing TKA. The statements reaching consensus form an important set of recommendation to improve patient selection and outcomes. Level of evidence Level V.
MATERIALS AND METHODS: The consensus statements were generated using an anonymized two-round modified Delphi questionnaire, sent to an international panel of 53 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics, with median as the measure of central tendency. Anonymized feedback was provided to all panellists based on responses from previous rounds to help generate the consensus.
RESULTS: 9 statements reached a consensus: WHO classification (87%), BMI cut-off for single-stage bilateral TKA (92%), use of tibial stem (84%), medial parapatellar approach (92%), same surgical approach as non-obese TKA (92%), inherent malnutrition (82%), higher risk of aseptic loosening in BMI class 3 (81%), need for time interval between bilateral TKA (88%), and consensus against leaving the knee in slight flexion (82%). The panel was unable to reach a consensus on 17 statements.
CONCLUSION: This indicates lack of consensus on a majority of issues among experts and further research is required in this field to address evidence gaps, so we can improve our management of this increasing cohort of patients undergoing TKA. The statements reaching consensus form an important set of recommendation to improve patient selection and outcomes. Level of evidence Level V.