Elsevier

The Journal of Arthroplasty

Volume 31, Issue 8, August 2016, Pages 1620-1624
The Journal of Arthroplasty

AAHKS Symposium: Modifying Risk Factors: Strategies that Work
Preoperative Optimization of Total Joint Arthroplasty Surgical Risk: Obesity

https://doi.org/10.1016/j.arth.2016.02.085Get rights and content

Abstract

Obesity is a problem that is increasing in prevalence in the United States and in other countries, and it is a common comorbidity in patients seeking total joint arthroplasty for degenerative musculoskeletal diseases. Obesity, as well as commonly associated comorbidities such as diabetes mellitus, cardiovascular disease, and those contributing to the diagnosis of metabolic syndrome, have been shown to have detrimental effects on total joint arthroplasty outcomes. Although there are effective surgical and nonsurgical interventions which can result in weight loss in these patients, concomitant benefit on arthroplasty outcomes is not clear. Preoperative optimization of surgical risk in obese total joint arthroplasty patients is an important point of intervention to improve arthroplasty outcomes.

Section snippets

Obesity and Comorbid Conditions in the TJA Population

Obesity has become a major health epidemic in the United States and in industrialized countries over the last several decades, and rates continue to rise. Obesity is most commonly defined as a BMI of more than 30. According to the CDC, from 1984 to 1998, the obese population increased by 22%. In 2012, 35% of the US population was considered to be obese (BMI > 30) [12]. Based on the National Health and Nutrition Examination Survey III sample, 63% of men and 55% of women >25 years old were

Impact of Obesity on TJA Technique

Obesity presents several challenges during the actual procedure as a result of body habitus which leads to increased operative time, increased blood loss, issues with retracting leading to suboptimal component positioning, and poor radiographic visibility. A retrospective study by Elson et al [21] evaluating obesity as a risk factor for suboptimal component positioning in THA found that morbidly obese (BMI > 35) patients had over-abducted and under-anteverted cup placement compared with the

Perioperative Complications in Obese TJA Patients

Although obesity leads to several perioperative issues, postoperative complications also are significant and can be devastating to the patient. It is not obesity alone that puts patients at risk for these complications but also the medical comorbidities such as diabetes and heart failure that often are associated with obesity. The most common adverse events that occur in the initial postoperative period are deep venous thrombosis, infection, and pulmonary embolus. Apart from the increased risk

Behavioral Weight Loss Programs in the Primary Care Setting

Although there is convincing evidence that obesity contributes significantly to adverse outcomes in TJA, which weight reduction strategies are most effective remains less clear. Bariatric surgery, programs available through primary care providers (PCPs), and commercially available programs such as Weight Watchers are all commonly used weight reduction modalities, but their overall efficacy is not known. PCPs, often serving as the patient’s first point of contact for both weight reduction and

Bariatric Surgery: Efficacy and Effects on TJA

Weight reduction techniques based on behavior modification rely on patient activation to achieve weight loss goals. When patient activation fails, surgical techniques remain an often-used option for weight reduction. Roux-en-Y gastric bypass (RYGB) is a commonly performed procedure that has been shown to have lasting benefits on weight reduction as well as comorbid diseases such as diabetes mellitus. Adams et al [32] compared RYGB patients with 2 control groups: 1 composed of a randomly

Pearls in the Operating Room

An obese patient can create challenges to TJA that are not encountered in nonobese patients. Consideration of these challenges and careful preoperative planning can help prepare for and avoid potential pitfalls in performing TJA on obese patients. Positioning of the obese patient can be challenging and is important to ensure that exposure is adequate and intraoperative measurements are accurate. The patient should be positioned on an operating room table that can accommodate his or her size

Conclusion

As the proportion of the US population older than 65 years continues to grow, the prevalence of degenerative musculoskeletal disease will increase and demand for TJA will continue to rise. Although TJA is a well-established and reliable intervention for degenerative arthritis, there are certain inherent risk factors. In concert with the overall increase in obesity nationwide, a significant number of patients seeking TJA are overweight or obese. Higher weight, BMI, and body fat percentage have

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These authors contributed equally to this work and are listed alphabetically.

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