Fred D. Cushner
ORLANDO — Orthopedic surgeons who perform joint reconstruction on patients who are obese should develop a plan to accomplish that goal in a way that is safe and successful for patients, according to a presenter who focused his talk on key considerations for performing total knee arthroplasty in this group of patients.
“My theory is let’s not avoid these patients. Let’s address the issues and do this operation safely,” Fred D. Cushner, MD, of Lenox Hill Hospital in New York, said at the Current Concepts in Joint Replacement Winter Meeting.
Enlisting the help of an extra surgeon was one part of the type of plan he discussed having in place.
“I would use patient-specific guides because of the obesity. I would probably extend the antibiotics,” said Cushner, who also suggested using an antibiotic wash and checking the patient’s nutrition.
“These are high-risk patients. I use a wound vac[uum],” he said.
When it comes to obese patients who undergo TKA, “I think there is an issue with tibial malalignment,” Cushner said. “These patients are hard to use conventional instruments on, so you can be smart and use smarter instruments.”
He said options for “smart” instruments include patient-specific instruments, “even navigation. They can help take some of that error out of the obese limbs.”
Lastly, Cushner shared a few surgical tips, such as not using minimally invasive techniques, being careful of the patient’s medial collateral ligament and using cement around the entire TKA prosthesis. – by Susan M. Rapp
Cushner FD. Paper 29. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 12-15, 2018; Orlando.
Disclosure: Cushner reports he is a consultant for Acelity and OrthAlign; and does consulting for royalties for Smith & Nephew.