Study: Orthopedists, Bariatric Surgeons Should Collaborate

New work performed at the Stanford University Medical Center highlights the value of collaborating with obesity medicine and bariatric colleagues in order to achieve optimal total joint arthroplasty (TJA) outcomes.

The review article, “Strategies for Weight Reduction Prior to Total Joint Arthroplasty,” appears in the November 7, 2018 edition of The Journal of Bone and Joint Surgery.

Highlighting the gravity of the obesity epidemic, the authors wrote, “Obesity is an independent risk factor for osteoarthritis, and patients with a body mass index (BMI) of ‡35 kg/m 2 are more likely to undergo TJA at a younger age.”

“A growing percentage of TKAs [total knee arthroplasty] being performed are in patients with obesity…There is a growing body of literature surrounding the increased arthroplasty-related risks associated with obesity, most notably infection and revision TJA…Achieving as little as 5% to 10% weight loss leads to substantial metabolic improvements, including improved glycemic control, lipids, blood pressure, and overall cardiac risk 3”

Co-author Derek Amanatullah, M.D., Ph.D. assistant professor of orthopaedic surgery at the Stanford University Medical Center, told OTW, “Orthopaedic surgeons are dealing with the obesity epidemic and need to become familiar with current options for weight loss when planning elective surgery.”

In the article, researchers outline options such as behavioral counseling to achieve lifestyle changes in diet and physical activity medications, Intragastric balloons, and bariatric surgery. They discuss the 5 A’s (assess, advise, agree, assist, and arrange) model for assessment and intervention (originally developed for smoking cessation). The authors wrote, “The Society of Behavioral Medicine developed the 5 A’s model, in which the physician provides a brief assessment and counseling and facilitates additional treatment for patients who are unsuccessful at losing weight with less intensive interventions…”

Dr. Amanatullah commented to OTW, “Most importantly, orthopaedic surgeons need to form collaborations with obesity medicine and bariatric surgery colleagues since established interventions have become safer and more effective than many orthopaedic surgeons imagine.”

“It is clear from population statistics that weight reduction prior to elective surgery will take on an increasing role in orthopaedic care. In our manuscript, we present several non-operative and operative weight loss tools available to assist patients through the process of optimizing their orthopaedic care.”