TY - JOUR T1 - Is the Whole Greater Than the Sum of Its Parts? JF - The Journal of Rheumatology JO - J Rheumatol SP - 1794 LP - 1796 DO - 10.3899/jrheum.100701 VL - 37 IS - 9 AU - TIL STÜRMER AU - KLAUS-PETER GÜNTHER Y1 - 2010/09/01 UR - http://www.jrheum.org/content/37/9/1794.abstract N2 - In this issue of The Journal, Rajiv Gandhi and coauthors from the Division of Orthopedic Surgery, University of Toronto, present data on patient-reported functional outcomes of 1596 patients one year after hip or knee arthroplasty as a function of preoperative metabolic abnormalities associated with the metabolic syndrome1. Their main finding is that individual metabolic abnormalities, mainly obesity, were stronger predictors of poorer functional outcomes compared with the number of metabolic abnormalities. The authors nevertheless conclude that functional outcomes are negatively affected by metabolic abnormalities, perhaps secondary to the systemic proinflammatory state1.In recent years a large number of different studies have been performed to investigate the influence of patient-specific cofactors (i.e., sociodemographic characteristics, preoperative function and activity level, body weight, comorbidity, patient expectation) on the outcome of joint replacement2,3. Among the risk factors for metabolic syndrome, obesity in particular has been studied extensively. Although the number of studies with adequate sample size and a sufficient number of morbidly obese patients involved is still limited, more recent data seem to support the finding that obesity can have a negative effect on postoperative function3,4 and surgical complication rates5,6. The exact mechanism is unclear, however, because obesity is not just a function of weight relative to height, but is associated with a … Address correspondence to Dr. Stürmer; E-mail: til.sturmer{at}post.harvard.edu ER -