Speaker says BMI cut-off for TJA ‘unreasonable’
LAHAINA, Hawaii — A presenter at Orthopedics Today Hawaii 2017 discussed difficulties orthopedic surgeons may face when performing total joint replacement on patients with a BMI of more than 30 and whether there should be a BMI cut-off for performing surgery in patients who are obese.
“I think our job is to try to help patients to present to us the best way they can, to be their guide,” David G. Lewallen, MD, said during his presentation. “These people are in trouble and they need our help, but we cannot do it alone. We need a team of people to try to address the multiple factors that are giving rise to the risk in these folks and sort out complexities of their care. We need to start now in gathering the resources and other specialties’ help. In the meantime, we need to do the best we can to reach these people one at a time.”
Lewallen noted complication rates go up in patients with a BMI of more than 30; but more importantly, there is an increase in the risk for infection. In patients with a BMI of 50, complication rates are higher and the risks of early hip dislocation and reoperation increase. However, Lewallen said the real issue for these patients is deep infection.
He highlighted findings of previously published literature on obese patients who underwent total hip arthroplasty and had infection and noted patients with a BMI of more than 40 had a reinfection rate of 16% and a reoperation rate for any reason of 59%. Other findings for patients who were superobese who underwent total knee arthroplasty showed good pain relief and improved knee scores, but high overall complication and deep infection rates (38% and 4.5%, respectively).
Lewallen said it is important to address morbid obesity and to optimize patients prior to surgery, but the problem is surgeons do not have the resources to do so.
“To bring the question to the floor, ‘Should we have a cut-off and a set number?’ I think that is unreasonable,” He said. “I think it is probably unethical. I do not think that it is the way to take care of patients, and it is a slippery slope.” – by Monica Jaramillo
Lewallen DG. Obesity and total joint arthroplasty — Should we have a weight limit. Presented at: Orthopedics Today Hawaii 2017; Jan. 8-12, 2017; Lahaina, Hawaii.
Disclosure: Lewallen reports no relevant financial disclosures.