Obese patients have high risk of complications after TJR, but high BMI does not contraindicate surgery
Obese patients who undergo total joint replacement have a higher risk of complications, but there is no body mass index level where the surgery would be contraindicated, according to a recent presentation, here.
“We understand that notable obesity increases most complications,” Daniel J. Berry, MD, said at the Current Concepts in Joint Replacement Winter Meeting. “There is no [body mass index] BMI threshold, but we should use good judgment in whether we operate on patients at a high BMI, and remember the rate of complications seems to rise fast above a BMI of 40.”
For patients who undergo total hip arthroplasty, complications such as nerve injury, infection and wound healing are increased, according to the abstract. Berry noted that although obese patients have lower functional and activity scores compared to nonobese patients, obese patients start with lower functional and activity scores so pain relief and postoperative change is comparable.
Berry said strategies for patients to lose weight before joint replacement surgery include diet and bariatric surgery. However, he noted weight loss through surgery may result in a patient who is malnourished. If a surgeon decides to perform total joint replacement surgery on an obese patient, Berry recommended optimizing metabolic, wound and anticoagulant management to reduce postoperative complications. Overall, he said it is important to include the patient in the decision-making process.
“Use good surgical judgment, consider carefully in each patient [whether] the risks are greater than the benefits and engage the patient in the shared decision-making process,” he said. “They understand they have a high body mass index. It is helpful for them to be engaged in the discussion so whatever the outcome of surgery they feel like they participated in the decision.”