Research Letter
A pilot study investigating dietetic weight loss interventions and 12 month functional outcomes of patients undergoing total joint replacement

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Summary

We conducted a pilot randomised controlled trial comparing the effects of a dietetic intervention to usual care, in 40 individuals with a body mass index >30 kg/m2 undergoing total joint replacement (TJR). The dietetic weight loss intervention comprised at least four sessions with an Accredited Practising Dietitian. At 12 months, the usual care group gained weight, +2.01 kg (6.45), whereas the treatment group lost weight, −3.38 kg (6.62), (p = 0.015). Percentage weight change in the treatment group was −3.20% (5.24), compared to +1.67% (6.16) for the usual care group (p = 0.015) and more participants in the intervention group (45%) lost ≥5% of their baseline weight (13%), (p = 0.057). Physical health scores were also better for the intervention group [42.2 (11.80); 32.86 (9.91), p = 0.014]. Findings suggest that a structured dietitian-led weight loss intervention in patients undergoing TJR is more effective in achieving weight loss than usual care, and can result in improved physical health scores at 12 months post-TJR.

Introduction

Total joint replacement (TJR) outcomes are inferior in obese compared to non-obese patients in terms of pain and function, complications and implant survival [1], [2], [3], [4]. Initiating weight loss interventions prior to surgery in obese patients with end-stage osteoarthritis (OA) poses a challenge given that disabling symptoms may limit an individual's motivation to participate. However, a majority of patients fail to lose weight after TJR despite symptom improvement and up to 25% of patients gain 5% or more of the baseline weight at 12 months [2], [3]. This is the first randomised controlled trial to investigate the effect of providing dietitian-led pre and post-operative weight loss interventions to a group of elective TJR surgery patients and compare clinical and patient outcomes to a group receiving usual care.

Section snippets

Methods

This Human Research Ethics Committee approved study was constructed in accordance with the CONSORT statement [5]. Between March 2012 and June 2013, 40 individuals with a BMI > 30 kg/m2 and <75 years of age with end-stage OA, consented for primary TJR, with no prior history of bariatric surgery, were recruited and randomised to the intervention or usual care arm (Supplementary Figure 1). The intervention group was referred to the study Accredited Practising Dietitian for a preoperative assessment,

Results

Baseline patient characteristics and clinical outcomes are presented in Table 1. Weight change and dietary data were available for 20/22 patients who received the intervention and 16/18 patients who received usual care. The intervention group demonstrated significant improvements in BMI, weight loss, FFB and % weight loss, compared to the usual care group (Table 2). There was no difference in pain, function and activity levels between groups, (Supplementary Table 1). Physical health scores were

Discussion

In this study, a dietitian-led weight management service was provided within the multidisciplinary pre-admission clinic for patients awaiting elective TJR, and results suggest this is a feasible and effective model of care. The changes in positive dietary behaviours were greater for the intervention group, indicating that the involvement of a dietitian significantly improves dietary behaviour irrespective of weight loss. This may have important implications for minimising future weight gain and

Conflict of interest

The authors declare that there are no conflicts of interest.

Acknowledgements

This study was funded by a St. Vincent's Hospital (Melbourne) Research Endowment Fund (05.2011).

Dr. Dowsey holds an NHMRC Early Career Australian Clinical Fellowship (APP1035810).

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