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Orthopaedics

Obesity linked to increase in knee and hip procedures

Excess body weight appears to be more damaging to the knee than to the hip

The number of total knee replacement (TKR) surgeries more than tripled between 1993-2009 and the number of total hip replacements (THR) doubled during the same time period, due to an increase in the prevalence of overweight and obesity population in the US.

The increase accounted for 95 percent of the higher demand for knee replacements, with younger patients affected to a greater degree, according to a study published in the Journal of Bone and Joint Surgery.

"We found that this differential growth rate in total knee replacement procedures could not be attributed to changes in physician or hospital payments, length of hospital stays, in-hospital death rates, or surgical work force characteristics," said lead study author, Dr Peter B Derman an orthopaedic surgery resident at the Hospital for Special Surgery in New York, NY. "Because excess body weight appears to be more damaging to the knee than to the hip, the increasing prevalence of overweight and obesity may explain the growing demand for knee replacements over hip replacements.”

Previous studies have found a strong link between a higher BMI and knee osteoarthritis. The effects of weight on hip osteoarthritis were less clear. In this study, researchers reviewed at least ten years of national data (through 2009) on TKR and THR volume, length of hospital stay, in-hospital mortality, and orthopaedic workforce trends.

The reported that patients aged 18 to 64 experienced a more rapid rise in overweight and obesity, compared to patients over age 65. From 1997 to 2009, the share of patients ages 18 to 64 undergoing TKR rose 56 percent, compared with only 35 percent for THR.

"If rates of overweight and obesity continue to climb, we should expect further acceleration in the number of knee replacements performed annually in the US with a more modest increase in hip replacement volumes," he added. "This knowledge can inform future policy decisions regarding health care funding and surgical workforce training as well as guide allocation of preventative health resources."

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