A new study published in the November issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) is suggesting that despite higher complication rates among obese patients, these individuals can benefit from orthopedic procedures.
HSS Study: Obese Patients Benefit From Surgery Despite Complications
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In the October 20, 2014 news release, William M. Mihalko, M.D., Ph.D., of Campbell Clinic Orthopaedics in Memphis, Tennessee, “obesity can accompany a multitude of comorbidities that can have a significant impact on a patient’s outcome from elective orthopaedic surgery.” The study, “Obesity, Orthopaedics, and Outcomes, ” suggests that obese patients can experience decreased pain and improve bone and joint function.
“Although no upper weight limits have been established that would contra-indicate elective orthopaedic surgery, every surgeon must understand the unique risks an obese patient faces and understand how to optimize and treat each of these patients on an individual basis, ” says Dr. Mihalko. The study authors recommend that patients with morbid obesity (BMI of 40 or higher) be:
- advised to lose weight before total joint arthroplasty (TJA)
- offered resources for weight loss before surgery
- counseled about the possible complications and inferior results that may occur if they do not lose weight
Asked what advice he might offer his colleagues about discussing weight loss with patients, Dr. Mihalko told OTW, “Orthopaedic surgeons need to treat and approach patients with obesity in a personalized manner. We need to understand the individual risk factors that each patient may be facing to determine whether delaying elective surgery to modify their risk factors is appropriate.”
He added, “Every patient with obesity is unique and may not possess the same risk factors for certain elective surgery. Knowing the individual risks that each patient may be subjected to, and what is modifiable, is necessary for every orthopaedic surgeon to help these patients minimize their risks and optimize their outcomes.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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