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RESEARCH PROPOSAL
Philip Drohat
Intern/Mentor
2017-2018

Title: A Heavy Truth: Weighing in on Obesity’s Effects of Total Knee Implants

Introduction and Overview of Research:

Knee osteoarthritis is becoming more common due to the increased commonality of
obesity (Salih & Sutton, 2013). Doctors are less likely to perform total knee arthroplasties on
obese patients because of speculation of poor recovery, so research must be done to determine if
this speculation has cause, or if it is just a myth waiting to be debunked (Rodriguez-Merchan,
2014, p. 167-170). The question will be answered by thorough research and data collection via
surveys to patients. From this a conclusion can be drawn, which will be presented to the
osteoarthritic community on a webpage in order to amplify the effects of the information.

Background and Rationale:

Obesity is becoming more prevalent in the United States; however, the real issues that
arise are the secondary problems that attach themselves to obesity: hypertension, hyperlipidemia,
diabetes, orthopedic issues, such as osteoarthritis, and more (Carson-DeWitt, 2002, p. 2373-
2378). Osteoarthritis sticks out especially because not only can obesity cause it, but it can also
worsen it, and osteoarthritis generally gets more severe as time goes on (Khan Academy, 2015).
Once the pain caused by the bone on bone articulation becomes too severe, or motion is limited
too much, a patient must undergo a total joint arthroplasty to replace the joint (Davidson, 2002).
Unfortunately, these joint implants are not indestructible; they have a general lifespan of 15
years (Davidson, 2002).
There are multiple factors that explain why the implant survives only around 15 years,
such as the materials used, how the implant is secured, infections, and weight of the patient
(Davidson, 2002). Since total knee arthroplasties are held in place by cement, use durables
materials, and is a weight bearing joint, it is the perfect joint for a deeper examination (Frey,
2015, p. 2878-2886). Although this surgery may seem beneficial to everyone, doctors are
skeptical when it comes to performing a total knee arthroplasty in obese patients because of their
increased risk for poorer outcomes (Rodriguez-Merchan, 2014, p. 167-170). Speculation for an
unfavorable outcome is derived from the idea that obesity will transfer stress through the implant
to the surrounding bone (Amin, Patton, Cook, & Brenkel, 2006, p. 335-340).
My internship is with an orthopedic surgeon who specializes in total hip and knee
arthroplasties, and many of these surgeries are due to osteoarthritis, which is the most common
type of arthritis (Hoyle, 2014, p. 328-329). Not only are knees a great joint to study for the
reasons above, but osteoarthritic knees are also very common at my site, suggesting a large pool
for data collection. The importance of this research stems from the fact that doctors shy away
when it comes to operating on obese patients, so the root of the problem needs to be discovered.
Obesity’s impact on the recovery of total knee arthroplasties becomes even more important since
obesity is becoming more prevalent in the United States and research has found that it is harder
to lose weight preoperatively when a patient had osteoarthritis (Stevens-Lapsley, Peterson,
Mizner, & Snyder-Mackler, 2009, p. 1104-1109).
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Research Methodology:
Research Question: Does the body mass index of an osteoarthritis patient who underwent a total
knee arthroplasty affect their recovery?
Research Hypothesis: Obesity will have a negative effect on the recovery of total knee
arthroplasties in osteoarthritis patients.
The two main elements that will be researched when it comes to recovery will be the
functionality gained from the surgery and the duration of time that the implant survives. From
baseline research in terms of functionality there is no general conclusion drawn between obesity
and function gained because of the conflicting literature (Amin et al. 2006, p. 335-340). Future
research in terms of functionality needs to look more specifically at distinct time periods after
surgery and compare between BMIs at each step. Research in terms of duration needs to be
looking at specific time periods after surgery to assess the condition of the implant, and finally
the overall life of the implant.
Research Design Model: I will be doing quantitative research, specifically a correlational study.
Since obesity can be measured on a scale, such as body mass index, it can easily be plotted
against net functionality gained or duration of implant in order to create a scatter plot and line of
best fit. From there a correlation or lack thereof can be concluded and a correlation coefficient
can be determined. The independent variable in this study is obesity, and it is defined as an
individual's body mass index. The dependent variable is the recovery of the surgery, and it is
defined by the duration of the implant and the functionality gained from surgery. Duration is
measured in years, and functionality gained is measured by a scoring system with the
preoperative scores subtracted from the postoperative scores.
Data Collection: Data collection will most likely only be for the functionality gained portion of
recovery due to the limited time the class provides for data collection. I will need to research
methods of gauging recovery in order to compile my own method. Data collection will most
likely take into account exercise, pain, stamina, and daily activity. The survey is planned to be
administered to patients around the one or two month period after surgery. This is where this
study’s data collections differs from other literature common on the web. It will be looking at the
immediate effects of obesity on recovery, while most people would look at some of the more
long term effects, whether that be a significantly longer term (years), or not as much (months). I
hope to my finding will be a support for the long term studies, mine showing the basis of the
effects.

Product Objectives:
After primary research, my goal is to create a website. A website would be an easy way
to make the information accessible to all who need it, and it is something that anyone could
familiarize themselves with. It would be one destination for someone to come gather information
about the risk of obesity when it comes to recovery of total knee arthroplasties in osteoarthritis
patients, but also providing information with how to have the most successful surgery possible.
The target audience will be the osteoarthritic community. The target audience will not be
limited to only those who plan on getting surgery or those who have osteoarthritis in the knee
because most of the research and information on the website could be applied to those who may
not yet have decided if they want surgery. The website could also possibly be applied to
osteoarthritic patients who suffer in their hip, because this is another weight bearing joint, and it
is also not uncommon for people with osteoarthritis to experience it in the hip and knee. A
second target audience could be orthopaedic surgeons. Although they have expertise in the field,
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a website with research in multiple areas surrounding recovery as well as suggestions for
successful recoveries may be something they look at themselves, or at least would recommend
their patients to look at. This would also be a possible way for the product to be communicated
to the audience, through the physician. Another possible way for the product to be communicated
to the audience could be a seminar in which the website was walked through, along with a
question and answer session to clear up any confusion and also get feedback for the website.

Logistical Consideration:
Since this class is only over the span of the school year, there are many things to consider
when it comes to data collection, especially since my topic involves examining patients as far as
10 years after surgery. For these reasons I have decided to look at the immediate effects that
obesity has on recovery. This will entail looking at patients around one or two months after
surgery, or gauging their rehabilitation process. I hope for the data collected about the immediate
recovery will serve as an explanation for the data about the more long term recovery (years).
There will be various resource types required for the product and project. As terms as the
research parts go it will be very heavy in media and print resources, because these will be the
evidence that will hopefully support the data. When it comes to collecting data this will be all
with human resources because it is all subjected to opinion in recovery. There will not be any
outstanding costs because data collection will take place at the internship site, and a website can
be made for free. Permission will need to be granted when it comes to data collection, but it will
be implicit, because by agreeing to fill out the surgery, the patient is granting permission for their
data to be collected. There will also be limited personal information collected: age, height, and
weight. The study will not ask for the patient's name or any identifying information.
In third quarter, a timeline will be added that outlines the data collection, product
development, and audience distribution.

References:
Amin, A. K., Patton, J. T., Cook, R. E., & Brenkel, I. J. (2006). Does obesity influence the
clinical outcome at five years following total knee replacement for osteoarthritis? Bone &
Joint Journal, 88, 335-340.
https://doi.org/10.1302/0301-620X.88B3.16488.

Carson-DeWitt, R. (2002). Obesity. The Gale Encyclopedia of Medicine, Vol. 4, 2373-2378.

Retrieved from
http://go.galegroup.com/ps/i.do?p=GVRL&sw=w&u=hcpub_hebron&v=2.1&it=r&id=G
ALE%7CCX3405601117&asid=c3f54b27bffd15fa94512c7a3497771a

Davidson, T. (2002). Joint Replacement, The Gale Encyclopedia of Medicine, Vol. 3 (2nd ed)
Retrieved from
http://go.galegroup.com/ps/i.do?p=GVRL&sw=w&u=hcpub_hebron&v=2.1&it=r&id=G
ALE%7CCX3405600886&asid=4428a35888bca5805d82def90a6cf77a

Frey, R. (2015). Knee Replacement. The Gale Encyclopedia of Medicine, Vol. 5, 2878-2886.
Retrieved from
http://go.galegroup.com/ps/i.do?p=GVRL&sw=w&u=hcpub_hebron&v=2.1&it=r&id=G
ALE%7CCX3623301054&asid=114d7c0fca7bfd0da2234edcd7e27bf9
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Hoyle, B. (2014). Arthritis. The Gale Encyclopedia of Science, 5th ed., Vol. 1, pp. 328-329.
Retrieved from
http://go.galegroup.com/ps/i.do?p=GVRL&sw=w&u=hcpub_hebron&v=2.1&id=GALE
%7CCX3727800197&it=r&asid=f1313beb5ac868c998089c06578eedd8

Khanacademymedicine. (2015, May 15). “Osteoarthritis vs rheumatoid arthritis symptoms |

NCLEX-RN | Khan Academy.” Retrieved from
https://www.youtube.com/watch?v=H-OoyU8Gb_Q

Rodriguez-Merchan, E.C. (2014). The influence of obesity on the outcome of TKR: can the
impact of obesity be justified from the viewpoint of the overall health care system. The
Musculoskeletal Journal of Hospital for Special Surgery, 10, 167-170. DOI:
10.1007/s11420-014-9385-9

Salih, S. & Sutton, P. (2013). Obesity, knee osteoarthritis and knee arthroplasty: a review. BMC
Sports Science, Medicine and Rehabilitation, 5. doi:10.1186/2052-1847-5-25

Stevens-Lapsley, J.E., Peterson, S.C., Mizner, R.L., & Snyder-Mackler, L. (2009). The impact of
body mass index on functional performance after total knee arthroplasty. The Journal of
Arthroplasty, 7, 1104-1109. doi:10.1016/j.arth.2009.08.009.