Abstract
Introduction
Morbid obesity (BMI>40) is a significant risk factor for complications following total joint arthroplasty (TJA). As such many have a restrictive practice of withholding elective primary TJA in the morbidly obese. The purpose of this study was to observe the implications of this practice.
Methods
From 2012 to 2014, 289 patients with morbid obesity and end-stage OA of the hip or knee were prospectively followed. At initial visit, patients were given a packet on risks of TJA in the morbidly obese and referral information to a weight loss clinic. Patients were contacted at 6, 12, 18 and 24 months from initial visit for PROs, and BMI changes. The average age of patients was 56 (26.7–79.1) there were 218 females and 71 males.
Results
The average BMI at initial visit was 46.9 (39.9–68.2). 85 patients (29%) refused additional follow up or to answer phone surveys regarding their status. 146 patients (50.5%) have not had surgery. Initial BMI in this cohort was 47.4 (39.9–68.6) and at last follow up was 46.8 (28.9–70.8). Of those, 11 (7.5%) had a last follow up BMI≤40. Only 23% of patients went to the bariatric clinic and 13% had bariatric surgery.
Fifty-eight patients (20.1%) underwent TJA. BMI at initial visit was 45.3 (40.3–55.4), and at the time of surgery was 41.3 (27.5–69.5). Only 20 patients (6.9% of those followed) have successfully achieved BMI < 40 and had surgery. Of those, 14 (70%) had a last follow up BMI≤40, and 2 (10%) had a last follow up BMI≤30.
Conclusions
The practice of restricting total joint replacement to morbidly obese patients does not serve as an incentive to lose weight prior to arthroplasty. Only 20% of patients ultimately underwent TJA and the majority of those remained morbidly obese. Better resources and collaborative care among specialties is required to optimize patients prior to surgery.
