Study shows weight loss prior to knee surgery improved outcomes for morbidly-obese patients

LAS VEGAS, March 12, 2019 /PRNewswire/ — Morbidly overweight patients who misplaced a minimum of 20 kilos prior to complete knee arthroplasty (TKA) had shorter hospital stays and decrease odds of getting to go to a nursing facility even when they remained morbidly or severely overweight, in accordance to a research introduced on the 2019 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Each yr, over 600,000 knee alternative surgical procedures are carried out in the United States.i The variety of morbidly overweight individuals present process TKA has risen steadily.ii Due to considerations about problems stemming from weight problems, many surgeons require morbidly overweight patients—these with a physique mass index (BMI) of 40 or higher—to lose weight earlier than the operation.

“There isn’t a standard practice for how much weight needs to be lost prior to surgery, nor is there a standard definition for clinically significant weight loss,” stated Benjamin Keeney, PhD, teacher in orthopaedics, Dartmouth Geisel School of Medicine. “With this paper, we tried to find the justification for losing five, 10 or 20 pounds. It’s hard to find where it explicitly states this is the amount of weight you need to lose for meaningful change, especially in the context of total knee arthroplasty.”

In the research, “How Much Preoperative Weight Do Morbidly Obese Patients Undergoing Total Knee Arthroplasty Need to Lose to Meaningfully Improve Outcomes,” Dr. Keeney and his colleagues needed to decide how a lot weight loss was crucial to enhance operative time, size of keep, discharge to a rehabilitation facility and bodily perform enchancment. The researchers retrospectively reviewed potential knowledge from 2011-2016, figuring out 203 patients who have been morbidly overweight at the very least 90 days prior to surgery. The patients misplaced no less than 5, 10 or 20 kilos earlier than present process TKA. After the weight loss, 27 patients have been not thought-about morbidly overweight and 23 have been thought-about severely overweight (35-40 BMI).

Patients with morbid weight problems who misplaced 20 kilos earlier than TKA had decrease odds of being discharged to a nursing facility, decrease odds of an prolonged size of keep of at the very least 4 days and an absolute shorter size of keep in contrast to patients who didn’t lose 20 kilos. The researchers discovered no distinction in operative time or bodily perform enchancment. Even if the patients remained morbidly or severely overweight, advantages have been nonetheless seen.

“While we don’t have a full understanding of the minimal weight loss necessary to improve outcome from a physiologic standpoint, our study supports even small increments of weight loss in patients undergoing knee replacement,” stated David S. Jevsevar, MD, MBA, senior writer and Chair of Orthopaedics at Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine. “Our work may also reflect weight loss as being a surrogate for patient activation and engagement, which have been shown to have significant impact on outcomes in this patient population.”

“Because length of stay and facility discharge are primary drivers of cost, quality of life, and satisfaction, this has immense implications,” stated Dr. Keeney. “If you lose at least 20 pounds before surgery, your outcomes are going to be much better, even if you are still a physically large patient at the time of surgery. This is a concrete goal instead of telling patients we won’t operate on you unless you get below a BMI of 40, which for some patients, can be 50 or 100 pounds.”

2019 AAOS Annual Meeting Disclosure Statement

About the AAOS
With greater than 39,000 members, the American Academy of Orthopaedic Surgeons is the world’s largest medical affiliation of musculoskeletal specialists. The AAOS is the trusted chief in advancing musculoskeletal health. It offers the very best high quality, most complete schooling to assist orthopaedic surgeons and allied health professionals at each profession degree greatest deal with patients of their day by day practices. The AAOS is the supply for info on bone and joint circumstances, remedies and associated musculoskeletal health care points and it leads the health care dialogue on advancing high quality.

i American Academy of Orthopaedic Surgeons. Total Knee Replacement. Accessed 1/31/19.
ii The weight problems epidemic: its impact on complete joint arthroplasty. Fehring TK, Odum SM, Griffin WL, Mason JB, McCoy TH. J Arthroplasty. 2007;22:71–76.

SOURCE American Academy of Orthopaedic Surgeons

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