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    Improving Outcomes in TKA Patients with Obesity

    Obesity affects 35 percent of the adult population in the U.S. A literature review published in the Journal of the American Academy of Orthopaedic Surgeons identifies strategies to improve outcomes of total knee arthroplasty (TKA) in patients with obesity.

    “Until recently, little was known about the outcomes of patients with obesity undergoing TKR,” said lead study author and orthopaedic hip and knee surgeon J. Ryan Martin, MD. “We sought to review what information is known and what areas need further investigation.”

    Co-author Jason M. Jennings, MD, told ICJR that based on their review, he and his colleagues recommend that surgeons managing patients with obesity:

    • Order laboratory screening tests for nutritional deficiencies, which may help identify patients at risk for perioperative complications such as infection or wound healing issues
    • Avoid the use of minimally invasive approaches – they may increase surgical times and ligamentous/tendon injury and may compromise the cutaneous blood supply
    • Have a low threshold for computer navigation to avoid malalignment and poor implant fixation caused by lack of visibility in the surgical site due to excess soft tissue
    • Use stemmed tibial component judiciously in patients with a BMI greater than 35

    Post-surgery, patients with obesity are at high risk for revision because of decreased longevity of implants and an elevated risk of infection. Currently, no study has evaluated methods for decreasing these complications, but data suggest it may be beneficial to utilize implants with improved fixation.

    “Although further research is needed, this review has allowed us to identify a variety of treatment methods to improve outcomes and reduce complications in patients with obesity,” said Dr. Martin.

    “We reviewed the most recent studies on obesity to provide perioperative guidance to improve and optimize outcomes based on our current evidence-based review.”

    Source

    Martin JR, Jennings JM, Dennis DA. Morbid obesity and total knee arthroplasty: a growing problem. J Am Acad Orthop Surg. 2017 Mar;25(3):188-194. doi: 10.5435/JAAOS-D-15-00684.