Obesity and Arthroplasty

This week I will be taking a break from my normal blogging material to talk about my literature review topic.  The topic I chose was arthroplasty in obese patients.  Arthroplasty is the replacement of a joint, usually due to osteoarthritis.  As a prospective medical student, I wanted to write about something that would be relevant to the field I want to go into.  With the obese population rising and the number of hip replacement surgeries expected to reach 500,000 per year 2030, this seemed like a good area to look into.

                What I found while doing this review is that high BMI (body mass index) patients, specifically the morbidly obese (BMI >40), have a greater risk of developing complications after surgery and having poorer outcomes than non-obese and even obese patients (Deakin et al, 2016).  Two other studies also found that the super-obese (BMI >50) were at even greater risk to develop complications (Arsoy et al, 2014) (Werner et al, 2017).  Despite these documented higher risks for complications and poor outcomes, surgeons continue to give morbidly obese patients arthroplasty procedures.

                This also goes back to my profile a professional essay.  When I asked an ER physician what advice he would give to prospective doctors he said, “always do what’s right for the patient.”  In many cases, arthroplasty is the only way that patients are able to get relief from the pain caused by osteoarthritis.  So, surgeons do what they can to relieve the pain by performing the procedure.  This view is supported by Krushell and Fingeroth’s 2007 study. 

                Patients need to be made aware of any risks they may incur as a result of the surgery, but they should continue to be able to choose a procedure that vastly improves their quality of life.

References:

Arsoy, D, Woodcock, JA, Lewallen, DG, Trousdale, RT.  (2014).  Outcomes and Complications Following Total Hip Arthroplasty in the Super-Obese Patient, BMI >50.  The Journal of Arthroplasty, 41, 1899-1905. http://dx.doi.org/10.1016/j.arth.2014.06.022

 Deakin, AH, Iyayi-Igbinovia, A, Love, GJ.  (2016).  A comparison of outcomes in morbidly obese, obese and non-obese patients undergoing primary total knee and total hip arthroplasty.  The Surgeon.  http://dx.doi.org/10.1016/j.surge.2016.10.005

Krushell, RJ and Fingeroth, RJ.  (2007).  Primary Total Knee Arthroplasty in Morbidly Obese Patients: A 5- to 14- Year Follow-up Study.  The Journal of Arthroplasty.  22(6), 77-80. doi:10.1016/j.arth.2007.03.024

Sechrest, RC. (10 November 2013). Artificial Knee Replacement. Retrieved from:  https://www.youtube.com/watch?v=m8LDBlZN-XM

Werner, BC, Higgins, MD, Pehlivan, HC, Carothers, JT, Browne, JA. (2017).  Super Obesity Is an Independent Risk Factor for Complications After Primary Total Hip Arthroplasty.  The Journal of Arthroplasty, 32, 402-406. http://dx.doi.org/10.1016/j.arth.2016.08.001