Primary Total Knee Arthroplasty in Super-obese Patients: Dramatically Higher Postoperative Complication Rates Even Compared to Revision Surgery

Obesity Epidemic: Is Its Impact on Total Joint Arthroplasty Underestimated? An Analysis of National Trends

“…Although it is possible that gender, age, and comorbidities can potentially modify the association of obesity with TJA, stratified risks based on gender, age, and each comorbidity for every procedure were not available and, hence, they could not be assessed. In the current study, obesity was considered as a single category (BMI C 30 kg/ m 2 ), although higher rates of complications are expected in morbidly obese and super obese patients [8,43]. Infection burden was analyzed for all TJAs (primary and revision) similar to previous studies, although separate analyses for primary and revision TJAs could have produced different results [22].…”

“…With knee and hip osteoarthritis being more prevalent in obese patients, it is not surprising that the rise in obesity rates is expected to be associated with an increase in use of total joint arthroplasty (TJA) in the United States [2,20,27,36]. Obese patients are also at a higher risk for complications after TJA, including infection, wound complications, and revision arthroplasty [8,14,18,40,42,43].…”

Percent Body Fat Is More Predictive of Function After Total Joint Arthroplasty Than Body Mass Index

“…The results of the current study would indicate that operative lower-limb weight would be the better predictor of the length of the surgical procedure. Similarly, percent body fat was clearly more predictive than BMI of perioperative medical complications, whereas current literature suggests a connection between only BMI and such outcomes 33 . BMI was a significant predictor of discharge to an extended-care facility, which confirms results from previously published reports examining total knee arthroplasty outcomes 34 .…”

2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions

“…Although there appeared to be strong consensus agreement, the social, political, and economic ramification of establishing an upper limit of the body mass index (BMI) threshold for elective surgery provoked strong arguments between delegates to the point that the question was removed without an official vote. Remarkably, subsequent high‐level peer‐reviewed research was published, which facilitated “unanimous” agreement for the 2018 ICM recommendations based on “Strong” and “Consensus” evidence of the risks (https://www.ors.org/wp-content/uploads/2019/01/BMI-Question.pdf). Other important outcomes of the 2013 ICM were: (i) an evidence‐based definition for hip and knee PJI that has been adopted by the Center for Disease Control (CDC), and (ii) several high‐impact publications as defined by over 1,000 downloads …”