Strategies and techniques administered before, during and after surgery may limit complications in total knee replacement patients with obesity

ROSEMONT, Ill. (March 1, 2017) — Obesity affects 35 percent of the adult population in the U.S. A new literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) identifies strategies to improve total knee replacement (TKR) outcomes in patients with obesity. 
 
TKR is a common orthopaedic procedure that is used to replace the damaged or worn surfaces of the knee, often caused by injury or osteoarthritis, to decrease pain and restore mobility for patients.
 
“Until recently, little was known about the outcomes of patients with obesity undergoing TKR,” said lead study author and orthopaedic hip and knee surgeon J. Ryan Martin, MD. “We sought to review what information is known and what areas need further investigation.”
 
According to the current review, prior to surgery, patients should:

• Be aware of, and try to manage, any chronic conditions, such as high blood pressure or diabetes.
• Decrease their body mass index (BMI), a measure of body fat based on weight in relation to height (a person whose BMI is greater than 30 kg/m² is considered to have obesity).
• Undergo testing for nutritional deficiencies to improve their surgical results. Malnutrition is common in people with obesity as well as in patients who are on low-calorie diets to lose weight. This could lead to poor wound healing and infection.

Researchers also found that excess soft tissue in patients with obesity can obstruct visibility in the treatment site during surgery. This lack of visibility can result in difficulty achieving proper alignment and implant fixation as well as longer surgical time. Techniques such as computer-assisted alignment may expedite surgery, and minimize complications.
 
Post-surgery, patients with obesity are at high risk for revision because of decreased longevity of implants and an elevated risk of infection. Currently, no study has evaluated methods for decreasing these complications, but data suggests it may be beneficial to utilize implants with improved fixation.
 
“Although further research is needed, this review has allowed us to identify a variety of treatment methods to improve outcomes and reduce complications in patients with obesity,” said Dr. Martin. “We reviewed the most recent studies on obesity to provide perioperative guidance to improve and optimize outcomes based on our current evidence-based review.”
 
About the AAOS
With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world’s largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues and it leads the health care discussion on advancing quality.

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Disclosures
From OrthoCarolina, Charlotte, NC (Dr. Martin), Colorado Joint Replacement, Denver, CO (Dr. Jennings and Dr. Dennis), and the Department of Bioengineering, University of Denver, Denver, theDepartment of Orthopaedics,University of Colorado School of Medicine, Aurora, CO, and the University of Tennessee, Knoxville, TN (Dr. Dennis). Dr. Martin or an immediate family member serves as a paid consultant to Zimmer Biomet. Dr. Jennings or an immediate family member serves as a paid consultant to DePuy Synthes and Total Joint Orthopedics and has received research or institutional support from DePuy Synthes and Porter Adventist Hospital. Dr. Dennis or an immediate family member has received royalties from DePuy Synthes and Innomed; is a member of a speakers’ bureau or has made paid presentations on behalf of and serves as a paid consultant to DePuy Synthes; has stock or stock options held in Joint Vue; and has received research or institutional support from DePuy Synthes and Porter Adventist Hospital.