Information and BMI limits for patients with obesity eligible for knee arthroplasty: the Swedish surgeons’ perspective from a nationwide cross-sectional study

Abstract

Background In the past decades, the incidence of obesity has increased worldwide. This disease is often accompanied with several comorbidities and therefore, surgeons and anesthesiologists should be prepared to provide optimal management for these patients. The aim of this descriptive cross-sectional study was to map the criteria and routines that are used by Swedish knee arthroplasty surgeons today when considering patients with obesity for knee arthroplasty. Methods A survey including 21 items was created and sent to all the Swedish centers performing knee arthroplasty. The survey included questions about the surgeons’ experience, hospital routines of preoperative information given and the surgeons’ individual assessment of patients with obesity that candidates for knee arthroplasty. Descriptive statistics were used to present the data. Results A total of 203 (64%) knee surgeons responded to the questionnaire. Almost 90% of the surgeons claimed to inform their patients with obesity that obesity has been associated with an increased risk of complications after knee arthroplasty. Seventy-nine percent reported that they had an upper BMI limit to perform knee arthroplasty, a larger proportion of the private centers had a BMI limit compared to public centers. The majority of the centers had an upper BMI limit of 35. Conclusion The majority of the knee arthroplasty surgeons in Sweden inform their patients with obesity regarding risks associated with knee arthroplasty. Most centers that perform knee arthroplasties in Sweden have an upper BMI limit.

Role of bariatric surgery in reducing periprosthetic joint infections in total knee arthroplasty. A systematic review and meta-analysis

“…Obesity stands as a paradoxical factor in Orthopedics due to its role as one of the major causes leading to a Total Joint Arthroplasty (TJA), and contextually, one of the most significant risk factors for joint replacement complications and failures [ 3 , 4 ]. International guidelines suggest joint replacement for patients with BMI > 40 kg/m2 should be avoided because the risk of postoperative complications may outweigh the benefit of the TJA [ 5 ]. Thus, surgeons must aim to induce BMI reduction in patients before the procedure [ 2 ].…”

Investigation of the predictive value of blood parameters and ratios on knee prosthesis loosening in patients after knee arthroplasty

“…The most common surgery used to treat severe medial osteoarthritis of the knee is total knee arthroplasty (2). In the rst 90 days following a primary total knee replacement for osteoarthritis, 4% of patients suffer a negative event, and 8% report being unsatis ed with the procedure (3). Pain in KA prosthesis without loosening and aseptic loosening both reduces life quality of patients after KA (4).…”

Consistent Factors Influence Body Mass Index Thresholds for Total Joint Arthroplasty Across Health-Care Systems

“…BMI thresholds are even applied at the institutional level 6,7 and have been connected to bundled payment models 8 . Surgeons in countries with different health systems, such as England 9 and Sweden 10 , have also reported the use of BMI thresholds. This suggests that additional supporting issues beyond reimbursement may need to be considered.…”