Younger TKA Patients Fatter Than Older

Stop blaming obesity among those 65 and older for the unprecedented increase in knee replacement surgeries. It turns out those under 65 are fatter! Data gathered by more than 125 orthopedic surgeons from 22 states across the U.S. revealed rising rates of obesity among those under the age of 65.

In the first 9, 000 patients whose outcomes were tracked in FORCE-TJR, the national research program led by researchers at the University of Massachusetts Medical School, 55% of patients under age 65 were considered technically obese compared to 43% age 65 and older.

“Our study shows that younger patients are more obese and experience the same amount of pain and functional disability as older patients and in some cases even more, ” said David Ayers, M.D., Chair of the Department of Orthopedics and Physical Rehabilitation and director of the Musculoskeletal Center of Excellence at the University Of Massachusetts Medical School.

The study found that twice as many younger patients were in the morbidly obese category with a body mass index greater than 40%—11% of those under age 65 versus 5% age 65 and older. The younger patients also had higher rates of smoking and lower mental health scores. “What we’re seeing is that the rise in obesity rates in younger people is having a dramatic influence on the number of total joint replacement surgeries, ” Ayers said. “These are not premature or unnecessary procedures.”

As reported by Almagest, obesity is not only a major predictor of knee replacement surgery; it also puts patients at a post-operative disadvantage compared to healthier patients. Regardless of age, those who are obese do not experience the same level of functional gain after joint replacement as do other patients. Obese patients are also more likely to get an infection or other complications that require readmission or revision surgery.

“Figuring out the best practices for rehabilitation and how to lose weight should be a priority, ” said Patricia Franklin, M.D., principal investigator of FORCE-TJR. “There needs to be a wellness incentive. Health insurers have done that around other diseases like diabetes and heart disease, but not joint replacement. We can’t just say we fixed the knee or the hip and then walk away.” Franklin will present the study findings at the annual meeting of the American College of Rheumatology and the Association of Rheumatology Health Professionals.