Being Underweight Is Associated with Worse Surgical Outcomes of Total Knee Arthroplasty Compared to Normal Body Mass Index in Elderly Patients

Purpose: Being underweight has never been studied in relation to the radiologic and clinical outcomes of total knee arthroplasty (TKA) in elderly patients. The aim of this study was to determine the effect of being underweight on TKA radiological and clinical outcomes and to investigate whether being underweight influences postoperative complications compared to normal body mass index (BMI) in elderly patients. Patients and Methods: A total of 118 female patients aged 65 years or older with BMI < 25 kg/m(2) who underwent primary TKA were divided into two groups based on BMI: group A: 18.5 kg/m(2) < BMI < 25 kg/m(2); group B: BMI < 18.5 kg/m(2). The radiologic and clinical outcomes were evaluated at follow-up of 6, 12, and 24 months after surgery such as the hipknee-ankle angle, the American Knee Society (AKS) score, Western Ontario and McMaster University score (WOMAC), and patellofemoral (PF) scale. Moreover, postoperative complications during follow-up were investigated. Results: Preoperative clinical scores did not differ significantly between the two groups. Postoperative WOMAC pain (1.8 +/- 1.9 versus 3.4 +/- 2.6, p = 0.02), WOMAC function (12.4 +/- 8.1 versus 16.5 +/- 8.5, p = 0.012) and PF scales (26.1 +/- 3.6 versus 23.7 +/- 4.1, p = 0.002) were worse in the underweight group at 12 and 24 months after surgery. The frequency of postoperative complications did not differ significantly between groups. In multivariate linear regression analysis, underweight patient group was significantly associated with worse postoperative WOMAC and PF scores (p = 0.002, 0.005). Conclusion: Although postoperative complications of TKA did not differ between groups, underweight patients had worse clinical outcomes of TKA compared to patients with normal BMI in elderly patients. Therefore, care should be taken when performing TKA in elderly underweight patients.