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Speaker: Obese patients should not be denied TJA
Developing perioperative protocols could help assess patients prior to undergoing total joint arthroplasty.
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KOLOA, Hawaii — Patients who are obese can safely undergo total joint arthroplasty when consistent pre-admission testing, perioperative medical management and use of rapid recovery protocols are used, according to Adolph V. Lombardi Jr., MD, FACS.
“Patients should be counseled about weight. The notion that [total joint arthroplasty] is unsafe [for obese patients] is invalid,” Lombardi, of Joint Implant Surgeons Inc., said during his presentation at Orthopedics Today Hawaii.
Effects of BMI
Lombardi presented a study that included 11,753 primary total joint arthroplasties (TJA) performed on 3,780 hips and 7,973 knees from January 2008 through April 2013. Forty-two percent of patients were male and 58% were female. The patients had an average age of 64.5 years and an average BMI of 32.6. Overall, 1% of patients had a BMI of 20 or lower; 42% had a BMI of 20 to 30; 42% had a BMI of 30 to 40; 12% had a BMI between 40 and 50; and 3% had a BMI greater than 50.
Adolph V. Lombardi Jr.
In their analysis on the impact of BMI on 30-day mortality following TJA, Lombardi and his colleagues found mortality rates of 1.94%, 0.16%, 0.16%, 0% and 0.28% for the BMI groups, respectively.
“Over 50% of our patients bad BMIs greater than 30,” Lombardi said. “When you look at overall 90-day mortality, however, it was higher in the lower BMI groups than it was in our higher BMI groups.”
The finding that high BMI was not a risk factor for postoperative mortality has been published in other studies literature, Lombardi added, with findings showing obesity as a risk factor for prosthetic joint infection, postoperative complications, wound infection and deep vein thrombosis.
“It would be unreasonable to deny patients arthroplasty purely based on BMI,” Lombardi said.
Premedical evaluation
According to Lombardi, previous research has shown higher complication rates after TJA among patients with diabetes, especially among patients with uncontrolled diabetes, as well as among patients with metabolic syndrome. Use of an effective premedical evaluation and clearance program could help identify good candidates for TJA, regardless of BMI level, Lombardi noted.
“You have to develop strategies for all different types of patients, not just the obese patients,” Lombardi said. “You need to assess nutritional status, you need to counsel about smoking cessation, obstructive sleep apnea, and perhaps the most importantly, getting good diabetic control.” – by Casey Tingle
References:
Lombardi AV Jr. The obesity epidemic and risk management. Presented at: Orthopedics Today Hawaii; Jan. 18-22, 2015; Koloa, Hawaii.
For more information:
Adolph V. Lombardi Jr, MD, FACS, can be reached at Joint Implant Surgeons Inc, 7277 Smith’s Mill Road #200, New Albany, OH 43054; email: lombardiav@joint-surgeons.com.
Disclosure: Lombardi is a consultant and on the speaker’s bureau for Biomet Inc. and Pacira; received royalties from Biomet Inc. and Innomed Inc.; received research support from Biomet Inc., Stryker, Pacira and Kinamed; and is a board member of Operation Walk USA, The Hip Society, The Knee Society and the Mount Caramel Education Center at New Albany.