In an article published by Dr. Fournier, MD, et al, in the August issue of the Journal of Arthroplasty, the effects of obesity on joint replacement were reviewed. The authors noted that the Center for Disease Control (CDC) predicts that the proportion of the U.S. population age 65 or older will increase from 12.4% in the year 2000 to 19.6% in the year 2030. This means that it is projected that 71,000,000 people will be over the age of 65 in 2030. Many of these patients require joint replacement surgery. The rewards of joint replacement surgery are great, but the risks associated with the procedure can have catastrophic implications. Obesity has been associated with increased complications after joint replacement surgery. According to the CDC, from 1984 to 1998, the obese population increased by 22%. In 2012, 35% of the U.S. population was considered obese (BMI greater than 30). A variety of studies have shown that patients who are obese have an increased number of medical comorbidities that can impact the outcomes after joint replacement.
Obesity has an impact on surgical technique in that the operation takes longer to perform, positioning of the patients can be challenging, component malposition happens more frequently in obese individuals, and there can be injuries to the surgical team as a result of handling the obese patient. Complications after surgery include an increased risk of wound complications, increase risk of infection, a higher likelihood of reoperation and readmission to the hospital, all of which will impact the cost of medical care. With the evolution of bundled payments where hospitals and health care systems will be liable for readmission rates, a greater screening of patients prior to surgery to optimize various medical comorbidities will be required to decrease the complication rate.
Over the next several years, patients will see and increased emphasis on optimizing medical comorbidities and overall health prior to surgical intervention to improve outcomes and decrease complication rates.