At the 21st annual meeting of the American Association of Hip and Knee Surgeons in Dallas, Texas in November of 2011, a survey of joint replacement surgeons was presented. Within the past year, 82% of respondents stated they had discouraged patients from having a hip or knee replacement because of obesity. The cutoff value was a BMI greater than or equal to 44. Many of these surgeons referred their patients to a bariatric program for weight loss. Diabetic patients with an A1c greater than 7.5 were referred to their internists for better management of their diabetes prior to scheduling surgery.
The results of this survey are consistent with a growing trend among joint replacement surgeons to encourage patients to decrease their preoperative risk factors, particularly obesity and control of their diabetes and to have good control of their medical conditions prior to undergoing elective hip and knee replacement surgery.
The influence of these comorbidities or preop medical issues will be greater in the coming years when payments for care are bundled together to include many postop complications and readmissions.�
William P. Barrett, MD