Abstract
The US obesity epidemic has transcended into the arthroplasty patient population and surgeons must assess whether obesity is a risk factor for poor outcomes in total joint arthroplasty (TJA) and determine how it should be managed in order to insure good clinical outcomes. In the United States, 34.9% of adults are currently obese (BMI > 30). In a recent study, 54.5% of patients reporting to arthroplasty clinics in the US were obese. We performed a recent literature review to determine how obesity impacts outcomes in total hip and knee arthroplasty and what must be done to improve outcomes in the obese arthroplasty patient.
We know that obesity and its associated comorbid conditions do have worse outcomes and increased complications in TJA patients. We also know that complications proportionately increase with increasing severity of obesity. The super-obese population is at the greatest risk of complication following TJA and pre-operative screening and management is essential in reducing complications. Although weight loss is important, our bariatric data has shown that it does not solve the problem of obesity in itself and the patient's metabolic state is likely a more important issue. Implant selection is important and strong consideration should be given to avoiding direct anterior approach in the THA obese patient. Understanding of obesity specific complications and treatment options is crucial for patient counseling and optimisation to ensure successful treatment in obese TJA patients.
