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Study: Higher proportion of obese patients present to arthroplasty clinics than national average
Weight loss support programs benefit patients, surgeons and health care systems.
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Recently published data showed 55% of patients who presented to orthopedic total joint clinics at a public tertiary hospital were obese.
“While only about 20% of hip and knee replacements are performed in obese individuals nationally, this study demonstrates a much larger percentage of obese patients seek consultation with a joint replacement surgeon,” K. Linnea Welton, MD, told Orthopedics Today. “This distinction highlights the opportunity doctors in this setting have for acting as advocates for obese patients.”
Increasing complications
Welton and her colleagues conducted a retrospective comparative study of 499 patients seen at total joint arthroplasty (TJA) clinics in the midwest, with 308 patients diagnosed with knee osteoarthritis (OA) and 191 patients diagnosed with hip OA. Charlson comorbidity index (CCI) scores were recorded and BMI was categorized using the WHO classification system. Investigators compared the proportion of obese patients from the TJA clinics with recently published national and regional obesity data for the general population from the CDC.
More comorbidities and higher functional CCI scores were seen in obese patients. Patients with Medicare/Medicaid were more likely to be obese than those who had private insurance. According a regression analysis, patients were more likely to be obese as their number of comorbidities increased.
Education on weight loss options
“This information will hopefully assist in properly stratifying these patients when surgeons and the facilities in which they practice are reimbursed and/or help in the development of better, more widely covered weight loss options for these patients prior to joint replacement surgery,” Welton said.
Patient weight loss could alleviate symptoms and reduce both perioperative risks and potential complications.
“The study highlights an orthopedic office might serve as a catch basin for these patients who need dietary counseling or more aggressive interventions and that orthopedic surgeons have strong incentives to offer patients if they can comply with dietary modification,” she said.
Orthopedic offices need to offer more dietary resources to help obese patients with weight loss, Welton said. She also stated the beneficial implications of patient weight loss support on the patients, surgeons and the health care system.
“We want to figure out how we can affect positive change for this patient population, as telling patients who have pain with walking that they simply need to lose weight is often not heeded as a viable piece of advice,” she said. — by Monica Jaramillo
- Reference:
- Welton KL, et al. Orthopedics. 2016; doi:10.3928/01477447-20151222-12.
- For more Information:
- K. Linnea Welton, MD, can be reached at the Department of Orthopaedic Surgery, University of Michigan, 2916H Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109; email: weltonk@med.umich.edu.
Disclosure: Welton reports no relevant financial disclosures.
Perspective
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Matthew Kraay, MD
This article highlights the recognized association between obesity and osteoarthritis (OA) and the increasing prevalence of obesity in patients seeking surgical treatment for end-stage OA of the knee and hip. Obesity is an epidemic and a risk factor not only for arthritis, but also for other significant health problems including diabetes, hypertension, obstructive sleep apnea and coronary artery disease. In many younger obese patients, OA may be the first symptomatic manifestation of obesity and the orthopedic surgeon is in a unique position to have a major impact on their patients overall health as well as optimize treatment of the joint-related problems they present to us with. As physicians, we need to advocate for our patients overall health and well-being and counsel our obese patients about the benefits of weight loss on their arthritis, surgical risk, outcome after joint replacement surgery and reduction of other obesity-related health problems.
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