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Bone Joint J. 2019 Jul;101-B(7_Supple_C):28-32. doi: 10.1302/0301-620X.101B7.BJJ-2018-1465.R1.

What are the implications of withholding total joint arthroplasty in the morbidly obese? A prospective, observational study.

Author information

1
OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA.
2
OrthoCarolina Research Institute, Charlotte, North Carolina, USA.
3
Novant Health Bariatric Solutions, Charlotte, North Carolina, USA.

Abstract

AIMS:

The aim of this study was to observe the implications of withholding total joint arthroplasty (TJA) in morbidly obese patients.

PATIENTS AND METHODS:

A total of 289 morbidly obese patients with end-stage osteoarthritis were prospectively followed. There were 218 women and 71 men, with a mean age of 56.3 years (26.7 to 79.1). At initial visit, patients were given information about the risks of TJA in the morbidly obese and were given referral information to a bariatric clinic. Patients were contacted at six, 12, 18, and 24 months from initial visit.

RESULTS:

The median body mass index (BMI) at initial visit was 46.9 kg/m2 (interquartile range (IQR) 44.6 to 51.3). A total of 82 patients (28.4%) refused to follow-up or answer phone surveys, and 149 of the remaining 207 (72.0%) did not have surgery. Initial median BMI of those 149 was 47.5 kg/m2 (IQR 44.6 to 52.5) and at last follow-up was 46.7 kg/m2 (IQR 43.4 to 51.2). Only 67 patients (23.2%) went to the bariatric clinic, of whom 14 (20.9%) had bariatric surgery. A total of 58 patients (20.1%) underwent TJA. For those 58, BMI at initial visit was 45.3 kg/m2 (IQR 43.7 to 47.2), and at surgery was 42.3 kg/m2 (IQR 38.1 to 46.5). Only 23 patients (39.7%) of those who had TJA successfully achieved BMI < 40 kg/m2 at surgery.

CONCLUSION:

Restricting TJA for morbidly obese patients does not incentivize weight loss prior to arthroplasty. Only 20.1% of patients ultimately underwent TJA and the majority of those remained morbidly obese. Better resources and coordinated care are required to optimize patients prior to surgery. Cite this article: Bone Joint J 2019;101-B(7 Supple C):28-32.

KEYWORDS:

Morbid obesity; Obesity; Optimization; Total joint arthroplasty

[Indexed for MEDLINE]

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