Patients with obesity are frequently advised to lose weight prior to total knee or total hip replacement. The reasons for this recommendation are numerous:
- Patients with obesity (BMI >30) are 1.7 times more likely to have complications after total joint replacement compared to patients with a BMI <30.
- Patients with a BMI >35 are 2.2 times more likely to have complications.
- Patients with a BMI >40 are 3.7 times more likely, and those with a BMI >50 are 21 times more likely to suffer complications.
Pre-surgery
Obesity is associated with many known risk factors for any surgical procedure. These include:
- Cardiovascular disease, including hypertension
- Type 2 diabetes
- Obstructive sleep apnea
- Metabolic syndrome
- Adiposopathic (sick fat disease) chronic inflammation
- Polypharmacy
Surgery
Obesity can also cause complications during surgery.
Challenges for the anesthesiologist may include:
- Locating proper venous access to administer general anesthesia and medications
- Alterations in body shape and anatomy that interfere with adequate oxygenation and airflow
- Proper needle positioning for delivering regional anesthesia (e.g. spinal and epidural nerve blocks
Obesity may also cause increased operative times due to technical challenges. The longer a surgery, the greater risk of complications. Obesity also increases the risk of nerve injuries and blood loss.
Post-surgery
Obesity can also increase complications after surgery:
- Infection and sepsis- studies have shown that patients with obesity have double the rate of infection following total knee arthroplasty
- Poor wound healing
- Deep vein thrombosis
- Pulmonary embolism
- Dyspnea and hypoventilation
- Prosthetic component loosening and failure due to biomechanical stress
- Dislocation of the joint replacement (especially the hip)
- Decreased joint mobility and range of motion compared to patients with healthy weight
- Difficulty participating in active rehabilitation due to an altered center of gravity and impaired balance
- Challenges with postoperative pain management
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