Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2.It is predicted that by 2030,48.9%of adults will be classified as obese which expands surgical risk factors to a broad population whil...Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2.It is predicted that by 2030,48.9%of adults will be classified as obese which expands surgical risk factors to a broad population while increasing healthcare costs at the same time in different socioeconomic groups.This specific population has been widely studied in multiple surgical fields and published studies have shown the implications in each of these fields.The impact of obesity on orthopedic surgical outcomes has been previously reported in several total hip and knee arthroscopy studies,with evidence indicating that obesity is strongly associated with an increased risk of post operative complications together with higher revision rates.In line with increasing interest on the impact of obesity in orthopedics,there has been a similar output of publications in the foot and ankle literature.This review article evaluates several foot and ankle pathologies,their risk factors associated with obesity and subsequent management.It provides an updated,comprehensive analysis of the effects of obesity on foot and ankle surgical outcomes,with the ultimate aim of educating both surgeons and allied health professionals about the risks,benefits,and modifiable factors of operating on obese patients.展开更多
BACKGROUND There appears to be a close relationship between deformities at the knee joint and at the hindfoot in patients with knee osteoarthritis(OA).Despite this intrinsic link,there is a dearth of studies investiga...BACKGROUND There appears to be a close relationship between deformities at the knee joint and at the hindfoot in patients with knee osteoarthritis(OA).Despite this intrinsic link,there is a dearth of studies investigating alterations in hindfoot alignment following total knee arthroplasty(TKA)in patients with knee OA.AIM To evaluate changes in alignment of the hindfoot following TKA,foot and ankle clinical outcomes in terms of subjective clinical scoring tools following surgical intervention,and to analyse the level of evidence(LOE)and quality of evidence(QOE)of the included studies.METHODS MEDLINE,EMBASE and Cochrane Library databases were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Studies reporting changes in the postoperative alignment of the hindfoot following TKA were included.The level and QOE were recorded and assessed.RESULTS Eleven studies with a total of 1142 patients(1358 knees)met the inclusion/exclusion criteria.Six studies were of LOE II and 5 studies were of LOE III.Patients with preoperative varus knee deformity and valgus hindfoot deformity demonstrated improvement in hindfoot alignment post TKA.Patients with preoperative varus knee deformity and varus hindfoot deformity demonstrated no improvement in hindfoot alignment following TKA.Twelve different radiographic parameters were used to measure the alignment of the hindfoot across the included studies,with the tibio-calcaneal angle most frequently utilised(27.3%).CONCLUSION This systematic review demonstrated that the hindfoot may display compensatory changes in alignment following TKA in patients with knee OA.However,the marked heterogeneity between the included studies and poor QOE limits any meaningful cross sectional comparisons between studies.Further,well designed studies are necessary to determine the changes and outcomes of hindfoot alignment following TKA.展开更多
文摘Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2.It is predicted that by 2030,48.9%of adults will be classified as obese which expands surgical risk factors to a broad population while increasing healthcare costs at the same time in different socioeconomic groups.This specific population has been widely studied in multiple surgical fields and published studies have shown the implications in each of these fields.The impact of obesity on orthopedic surgical outcomes has been previously reported in several total hip and knee arthroscopy studies,with evidence indicating that obesity is strongly associated with an increased risk of post operative complications together with higher revision rates.In line with increasing interest on the impact of obesity in orthopedics,there has been a similar output of publications in the foot and ankle literature.This review article evaluates several foot and ankle pathologies,their risk factors associated with obesity and subsequent management.It provides an updated,comprehensive analysis of the effects of obesity on foot and ankle surgical outcomes,with the ultimate aim of educating both surgeons and allied health professionals about the risks,benefits,and modifiable factors of operating on obese patients.
文摘BACKGROUND There appears to be a close relationship between deformities at the knee joint and at the hindfoot in patients with knee osteoarthritis(OA).Despite this intrinsic link,there is a dearth of studies investigating alterations in hindfoot alignment following total knee arthroplasty(TKA)in patients with knee OA.AIM To evaluate changes in alignment of the hindfoot following TKA,foot and ankle clinical outcomes in terms of subjective clinical scoring tools following surgical intervention,and to analyse the level of evidence(LOE)and quality of evidence(QOE)of the included studies.METHODS MEDLINE,EMBASE and Cochrane Library databases were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Studies reporting changes in the postoperative alignment of the hindfoot following TKA were included.The level and QOE were recorded and assessed.RESULTS Eleven studies with a total of 1142 patients(1358 knees)met the inclusion/exclusion criteria.Six studies were of LOE II and 5 studies were of LOE III.Patients with preoperative varus knee deformity and valgus hindfoot deformity demonstrated improvement in hindfoot alignment post TKA.Patients with preoperative varus knee deformity and varus hindfoot deformity demonstrated no improvement in hindfoot alignment following TKA.Twelve different radiographic parameters were used to measure the alignment of the hindfoot across the included studies,with the tibio-calcaneal angle most frequently utilised(27.3%).CONCLUSION This systematic review demonstrated that the hindfoot may display compensatory changes in alignment following TKA in patients with knee OA.However,the marked heterogeneity between the included studies and poor QOE limits any meaningful cross sectional comparisons between studies.Further,well designed studies are necessary to determine the changes and outcomes of hindfoot alignment following TKA.
