An article published in the July issue of the Journal and Bone Surgery by Dr. Jamsen, et.al. from Finland, outlined the affects of diabetes and obesity on the risk of infection after hip and knee replacement. They analyzed a series of 7,181 primary hip and knee replacement performed between 2002 and 2008. The one year infection rate in that series of patients was 0.72%. When they broke out the infection rate by weight and diabetes it was found that patient’s who had a more normal body mass index (less than 30) the infection rate was 0.37% versus an infection rate of 4.66% in patients with a BMI over 40, considered morbidly obese. The highest infection rate was in morbidly obese patients (BMI over 40) who were diabetic. The infection rate in that cohort of patients was almost 10%. This is further evidenced that the combination of morbid obesity and diabetes places patients at significant risk for infection following hip and knee replacement. Therefore, it is imperative for patient’s who are in that risk category to use all measures possible to reduce their weight and improve their health prior to joint replacement so that they can lower their risk to a more acceptable rate. Recent articles have demonstrated good results in obese individuals with regard to pain relief and function. However, the significant increase in risks places a big strain not only on the individual patient, but on the healthcare system in general.
—William P. Barrett, MD