Denying Obese Patients Joint Surgery Is a Dead End

One might think that simply putting restrictions on elective total joint surgery for those who are severely overweight might encourage weight loss.

Not necessarily so, says new work from OrthoCarolina and Novant Health Bariatric Solutions. Such an endeavor requires a different, more problem solving and supportive approach, says new research.

The study, “What are the implications of withholding total joint arthroplasty in the morbidly obese? a prospective, observational study,” appears in the June 30, 2019 edition of The Bone and Joint Journal.

Bryan Springer, M.D., associate professor in the Department of Orthopedic Surgery at OrthoCarolina and co-author explained both the problem and the, perhaps, counterintuitive outcome to OTW, “We know that total joint arthroplasty in the morbidly obese (Body Mass Index (BMI) > 40) carries with it a higher risk of complications, including infection.”

“It has been our policy in our practice to restrict the morbidly obese from having elective total joint arthroplasty until they could optimize their weight. We were curious however how often these patients were actually able to lose weight by simply saying they could not have surgery. The concern was that we were not offering them resources to assist in weight loss prior to surgery.”

“We looked at nearly 300 patients that were morbidly obese and otherwise would have qualified for total joint replacement (end stage OA [osteoarthritis] and failure of conservative management). We followed them for 2 years. What we found was that very few (only 19%) went on to have total joint replacement and of those very few actually had their BMI < 40. For those patients that did not have surgery, they were unable to lose weight and in fact their weight increased. Over 1/3 of the patients never came back to our office.”

“One thing people might interpret from this study is that patients can’t lose weight so you might as well go ahead and do their surgery anyway. That is not the message. As stated previously we know these patients are at higher risk. The message from this study is that patients need help and they need resources to help them lose weight. Just like we would provide them with resources to optimize their cardiac condition, their diabetes etc., we need to do the same to manage obesity.”

“If we are going to put barriers in place (restrictions) then we must provide resources and solutions. From this work, our group has established a patient optimization program that partners with bariatric and weight loss center at our institution to ensure patients have resources and help to become as optimized as possible prior to surgery.”