According to the World Health Organization, obesity is a global health epidemic, which has nearly tripled in prevalence since 1975.Worldwide in 2016, 13% of adults 18 years and older had obesity (body mass index $ 30 kg/m 2 ) and 39% were overweight (body mass index 25.0 to 29.9 kg/m 2 ). In the United States, approximately 35% of adults have obesity and 31% are overweight. Obesity increases stress throughout the musculoskeletal system and carries a higher risk for the development of osteoarthritis and various other musculoskeletal conditions. When patients with obesity undergo orthopaedic procedures, weight loss is a critical aspect to appropriate preoperative counseling and treatment. Weight loss can improve obesity-related comorbidities such as metabolic syndrome, diabetes, cardiovascular disease, and obstructive sleep apnea, which in turn may reduce complications, minimize long-term joint stress, and improve outcomes among patients undergoing orthopaedic procedures. The effects of obesity on patients undergoing total joint arthroplasty has been previously described, with reported associations of increased risk of infection, revision, blood loss, venous thromboembolism, and overall costs. The purpose of this article was to provide orthopaedic surgeons with strategies for obesity treatment.A ccording to the World Health Organization, obesity is a global health epidemic, which has nearly tripled in prevalence since 1975. Worldwide in 2016, 13% of adults 18 years and older had obesity (body mass index [BMI] $ 30 kg/m 2 ) and 39% were overweight (BMI 25.0 to 29.9 kg/m 2 ). In the United States, approximately 35% of adults have obesity and 31% are overweight. 1 BMI is a person's weight in kilograms (or pounds) divided by the square of height in meters (or feet). Obesity increases stress throughout the musculoskeletal system and carries a higher risk for the development of osteoarthritis and various other musculoskeletal conditions. Sarcopenic obesity is associated with an increased risk of all-cause mortality, new-onset depression, gastric cancer, insulin resistance, vitamin D deficiency, and inflammation. 2 Treatment of sarcopenic obesity includes strength training exercise programs. When patients with obesity undergo orthopaedic procedures, weight loss is a critical aspect to appropriate preoperative counseling and treatment. Weight loss can improve obesity-related
Introduction: The purpose of the study was to quantify the volume of graft that is obtained using sequential upsizing of reamers using the modularity of the second generation Reamer-Irrigator-Aspirator (RIA 2) system and determine any fracture or perforation risk with upsizing. We hypothesize that graft volume may be predicted using radiographic variables that can be measured before reaming. Materials and Methods: Eleven cadaveric specimens were used to evaluate the sequential amount of graft taken using the RIA 2 modular system. Each cadaveric specimen had bone graft harvested from the tibia and femur. Using a radiographic ruler, estimations of the canal size for both the femur and tibia were performed. Average graft volume with SD per incremental increase of reamer was calculated for both the femur and the tibia. Results: There were no perforations of the femur during any reaming. There were 5 perforations or fractures of the tibias during progressive reaming including 3 during the second pass and 2 during the third pass, with a significant increase in perforation in the tibial specimens (P=0.03). There was no significant difference in graft volume after 3 passes from either tibia or femoral harvesting. However, there was a significant decrease in graft volume on the second pass of the femur that was not seen in tibial harvesting (P=0.0013). Discussion: The RIA 2’s reamer head modularity allows multiple passes of the reamer, which gives surgeons the ability to upsize if more autograft is needed. Total autograft volume was similar between the femur and tibia; however, caution should be used in the tibia because of increased perforation risk. Level of Evidence: Level IV—therapeutic study.
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