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Obesity: A global epidemic that poses challenges for total joint replacement
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 Steven J. MacDonald |
Total joint arthroplasty in obese patients will continue to be an important challenge for orthopedic surgeons based on data presented at the Current Concepts in Joint Replacement 2011 Winter Meeting, here.
“If you think that [obesity] is a U.S. trend, that is wrong,” Steven J. MacDonald, MD, FRCS(C), said in his presentation. “Most countries are in the clear double digits, and many not that far off,” he said.
Patients with a body mass index (BMI) greater than 40 have an 8.5 times higher risk of needing total hip arthroplasty (THA) and a 32 times higher risk for a total knee arthroplasty (TKA) compared with patients with a normal BMI, according to MacDonald.
“Obesity in total joint arthroplasty — it increases the number of procedures and the burden. There are increased complication rates,” he said.
Infection is a one challenge, MacDonald noted.
“Most series powered enough will start to show the trend of increasing infection rates, both superficially — and sometimes deep — with the morbidly obese patient,” he said.
However, the difficulty of performing THA or TKA in obese patients is unquestioned, MacDonald said.
“There is no evidence that obesity affects implants or survivorship,” he said, noting this may be because obese patients put their prostheses through fewer cycles per year on average.
Based on changes between preoperative and postoperative WOMAC, SF-12 and the Hip Society scores for THA in obese vs. normal weight patients that MacDonald and colleagues studied, “The procedure is doing what it is meant to do,” MacDonald said.
Reference:
- MacDonald SJ. Patient obesity: Getting to the refrigerator faster. Paper #86. Presented at the Current Concepts in Joint Replacement 2011 Winter Meeting. Dec. 7-10. Orlando, Fla.
- Disclosure: MacDonald has no relevant financial disclosures.
Total hip arthroplasty (THA) and knee replacement (TKA) in obese patients was discussed decades ago to be either denied or delayed until body mass index has reached a normal level. However, as obesity is now a global epidemic, mainly in the Western world, we as joint replacement surgeons need to focus on new approaches to our obese patients. Most important is to realize that THA and TKA in extremely obese patients is a demanding surgery and should only be undertaken by experienced, high-volume surgeons to minimize the risks for complications. Moreover, as obesity is frequently followed by metabolic diseases, like diabetes and arteriosclerosis, the risk for deep infection or skin necrosis is dramatically increased in TKA. Therefore, we must inform our obese patients about this and also about potential outcomes of deep infection in the new joint as well as severe morbidity, arthrodesis and amputation. It is the patient’s right to deny surgery but [it is] also the surgeon’s duty to give the information followed by documentation in the record. Finally, clinics performing THA and TKA in severely obese patients should be aware of the quality of their surgical tables, as most tables cannot handle high weights.
— Per Kjaersgaard-Andersen, MD
Chief Medical Editor, Orthopaedics Today Europe
Disclosure: Kjaersgaard-Andersen has no
relevant financial disclosures.