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Speaker: Health care systems need to be aware of obesity, TJA link
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LAHAINA, Hawaii — With the increasing global prevalence of obesity, public and health care systems need to be aware of the link between obesity and total joint arthroplasty, according to a speaker at Orthopedics Today Hawaii 2017.
“We talk about worldwide issues, and this is clearly one of the biggest worldwide issues we have. It is a leading public health concern and increasing in incidence and prevalence around the world. It is a global epidemic,” Steven J. MacDonald, MD, FRCSC, said.
He said during the past 20 years, the prevalence of obesity, defined as BMI greater than 30, has doubled in adults and tripled in children and adolescents. In addition, the heaviest BMI groups are increasing at the fastest rates and obesity is now the fifth leading global risk for death.
MacDonald said published studies have shown a strong cross-sectional relationship between obesity and joint replacement arthroplasty. Likewise, the increase of obesity is driving up the number of knee replacements more than it is the number of hip replacements.
“Obesity is a major driver. The underlying incidence does not change,” he said.
As far as complications, MacDonald said studies have shown that once patients get through the perioperative risk period, they do well. Likewise, there is no evidence obesity influences implant survivorship.
“Preoperative weight loss and gastroplasty is something we can all discuss, as it makes sense in light of postoperative findings. It makes it technically easier to do the surgery, but it may not substantially change the risk profile for patients,” he said.
MacDonald said obese patients need to be informed of increased risks for infection and thrombosis. Providers also need to be aware patient outcomes are good once obese patients are through the perioperative risk period and that there could be increased costs. However, denying patients based access to total joint arthroplasty based on BMI alone, does not do justice to the issue, he said. – by Kristine Houck, MA, ELS
Reference:
MacDonald SJ. Obesity in TJA. Presented at: Orthopedics Today Hawaii 2017; Jan. 8-12, 2017; Lahaina, Hawaii.
Disclosure: MacDonald reports he receives institutional/educational support from Smith & Nephew, DePuy and Stryker; is a consultant for and receives royalties from DePuy; and is a stockholder in Hip Innovations Technologies and JointVue.