Nutritional counseling may lead to safer TJA for patients with morbid obesity
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Formal nutrition counseling with a dietitian prior to surgery may lead to safer, more successful total joint arthroplasty in patients with morbid obesity, according to published results.
From July 2016 to July 2018, researchers referred 133 patients above the BMI cutoff of 40 kg/m2 for nutritional counseling with a dietitian prior to total knee arthroplasty (94 patients) or total hip arthroplasty (39 patients). The procedures were performed at a single tertiary-care TJA institution and had a minimum follow-up of 4 months.
“Outcomes included weight loss, change in BMI, duration of counseling and surgical status,” the researchers wrote in the study, and complications were recorded up to 90 days postoperatively.
“A total of 102 (92%) patients achieved weight loss during a mean 154 days (range, 8 [days to] 601 days),” the researchers wrote. “Patients lost a mean of 17 lbs., lowering their BMI by 2.7 points (range, +6.3 to -17.7 points).”
According to the study, 71 patients, or 64% of those who participated in more than one nutritional counseling session, successfully underwent their respective procedure. Seven patients reported postoperative complications including delayed wound healing, periprosthetic fracture, infection, cellulitis and peroneal nerve palsy, the researchers wrote.
The researchers concluded that a weight optimization protocol with a dietitian prior to TJA allowed for safer, more successful procedures and could be an alternative to other “more invasive interventions such as preoperative bariatric surgery, which has not conclusively demonstrated risk reduction after TJA,” they wrote.
“Surgeons must actively counsel obese patients about weight optimization as part of the preoperative standard of care,” the researchers added. “Given the forecasted increase in obesity and need for arthroplasty, it is essential that all possible measures to curb the increased complication rate and subsequent burden of revision surgery be fully evaluated,” they wrote.
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