This is the Editorial from the current edition of the Journal of Arthroplasty. The AAHKS is the American Academy of Hip and Knee Surgeons. There has been a great deal of debate about the effect of obesity on the outcome of joint replacement. It is certainly the case that obese patients get good pain relief from joint replacement, but the risk of complications is higher. Rising rates of obesity are going to have a big impact on all aspects of healthcare…….
‘Total joint arthroplasty surgeons are fortunate to enjoy offering a truly successful surgical procedure to their patients with disabling arthritis. Although no one disputes the success of TJA, we are all aware of the complications that can happen after this procedure. It is known that some patient factors play a crucial role in increasing the risk of complications after TJA, leading some to believe that elective TJA is not for all. While efforts are underway to determine the “appropriateness criteria” for elective arthroplasty, a group of experts from the AAHKS, lead by Dr Bryan Springer, have examined the available literature to determine if obesity predisposes patients to added risk of complications after TJA, and if so is there a threshold for weight or body mass index beyond which the patient should not be subjected to elective arthroplasty.
The group should be applauded for their accomplishments that are summarized in the lead article in this month’s issue. The findings of this workgroup are that obesity does indeed increase the risk of complications following both total hip and knee arthroplasty. Although the literature does not provide a conclusive evidence for the weight or BMI threshold, the workgroup, based on their understanding of the available evidence, has chosen BMI of 40 kg/m2 as the cut-off. I am certain there will be many discussions over the coming months with some arguing that this “selected” threshold is either too high or too low. Regardless of what BMI threshold we choose, the findings of this workgroup compel us all to consider that there are indeed contraindications for elective arthroplasty and this otherwise successful procedure should not be offered to all. Patients should be held accountable and efforts should be exercised by both the patient and the healthcare to reverse adverse factors such as obesity prior to elective surgery.’
