VIDEO: Work collaboratively to optimize patients with obesity preoperatively
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Key takeaways:
- Patients with morbid obesity are at an increased risk for infection.
- Glucagon-like peptide-1 receptor agonists for weight loss could help optimize patients with obesity for total joint arthroplasty.
WAILEA, Hawaii — At Orthopedics Today Hawaii, David G. Lewallen, MD, spoke about management of the morbidly obese patient undergoing total joint arthroplasty.
“The problem is mostly increased risk of infection. [For] patients who are obese, especially the morbidly obese, it’s not the case that there are major problems with breakage or loosening or wearing out joints to implant materials and fixation is fairly robust with some exceptions,” Lewallen said.
Lewallen said that obesity is like other comorbidities patients present with, and part of the job of orthopedic surgeons is to work collaboratively with other specialists to get patients in the best state they can be before surgery.
“Like a cardiac patient, you can’t make them normal in terms of their heart, but you can make them the best they can be and the safest [the] procedure can be for them before proceeding. And that’s the way we view the problem with obese patients,” Lewallen said.
Traditional bariatric surgery before total joint arthroplasty has not proven to have much benefit and may even present with worse results for patients, Lewallen said. However, some of the newer gastric banding and the partial gastrectomy sleeve procedures have shown improved results based on latest literature. New glucagon-like peptide-1 receptor agonists for weight loss could help optimize patients with obesity for total joint arthroplasty.
“It’s our obligation to try to do the best we can to take care of these patients in a comprehensive way. And we’ll look forward to doing a better job of that as the years go by,” Lewallen said.
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Lewallen DG. Managing the morbidly obese patient. Presented at: Orthopedics Today Hawaii; Jan. 7-11, 2024; Wailea, Hawaii.
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