Knee replacement not an "easy solution" for obese patients

Obesity related to higher rates of infection and other complications following surgery

ROSEMONT, Ill., Oct. 24, 2012 /PRNewswire-USNewswire/ -- Obese patients have a greater risk of complications following total knee replacement surgery, including post-surgical infections, according to a new literature review recently published in the Journal of Bone and Joint Surgery (JBJS). Because of complications, obese patients are more likely to require follow-up surgery (revision).

Obesity is reaching epidemic proportions, particularly in the United States, and is a well-documented risk factor for the development of osteoarthritis. Arthritis is initially treated nonsurgically, but total joint replacement often becomes necessary if the disease progresses. Consequently, the rate of joint replacements in obese individuals has increased in the last several decades.

"Orthopaedic operations can technically be more difficult in obese people, and it is important for us to know whether there is a higher complication rate in the obese, and if the long-term outcome is worse," says Gino M.M.J. Kerkhoffs, M.D., Ph.D., an orthopaedic surgeon at the Academic Medical Center Amsterdam, University of Amsterdam, and lead author of the study.

Findings include:

• Obese patients have double the rate of infection following total knee replacement surgery compared to non-obese patients.
• Obese patients' rate of infection is higher for both superficial and deep infections.
• The long-term surgical revision rate for obese patients is nearly double that for non-obese patients.

The paper's authors advise that knee replacement surgery not be withheld from obese patients. Rather, obese patients should be well-informed of the likelihood of complications following their total knee replacement, and advised to lose weight before surgery. Orthopaedic surgeons should be prepared to refer them to medical weight-loss professionals, if necessary. The authors also note that weight loss could lessen some patients' osteoarthritis symptoms.

"Although these results are not really surprising," Kerkhoffs says, "for the obese patient, this literature sheds new light on treatment options for symptomatic knee osteoarthritis: a total knee replacement is not the 'easy solution.'"

More information about total knee replacement and obesity can be found at orthoinfo.org.

About JBJS or access to the study abstract.

Full JBJS Table of Contents
Twelve-year risk of revision following primary total hip replacement in the US Medicare population

Predictive Factors of Knee Stiffness After Peri-articular Fracture: A Case Control Study

The Influence of Obesity on the Complication Rate and Outcome of Total Knee Arthroplasty: A Meta-analysis

Transient Soft-Tissue Edema Associated with Implantation of Increasing Doses of rhBMP-2 on an Absorbable Collagen Sponge in an Ectopic Rat Model

A Comparison of Two Approaches to the Closed Treatment of Low-Energy Tibia Fractures in Children

Association Between Acromion Index Size and Outcomes Following Arthroscopic Repair of Full Thickness Rotator Cuff Tears

Isolated Involvement of the Posterior Elements in Spinal Tuberculosis: A Review of Twenty-four Cases

Risk Factors for Periprosthetic Ankle Joint Infection: A Case-Control Study

Successful Long-Term Fixation and Progression of Osteolysis in First-Generation Cementless Acetabular Components Retrieved Postmortem

Axial Rotation moment Arms of the Shoulder Musculature After Reverse Total Shoulder Arthroplasty

With more than 37,000 members, the American Academy of Orthopaedic Surgeons, (www.aaos.org) or (www.orthoinfo.org) is the premier not-for-profit organization that provides education programs for orthopaedic surgeons and allied health professionals, champions the interests of patients and advances the highest quality of musculoskeletal health. Orthopaedic surgeons and the Academy are the authoritative sources of information for patients and the general public on musculoskeletal conditions, treatments and related issues.

More than one in four Americans have bone or joint health problems, making them the greatest cause of lost work days in the U.S. When orthopaedic surgeons restore mobility and reduce pain, they help people get back to work and to independent, productive lives. Orthopaedic surgeons keep this "Nation in Motion." To learn more about A Nation in Motion campaign, or to read hundreds of patient stories or to submit your own story, visit anationinmotion.org

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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

SOURCE American Academy of Orthopaedic Surgeons