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