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Orthopaedic surgery

Obese patients face greater risks from orthopaedic surgery

Obese patients had a significantly higher risk of infection after orthpaedic surgery. Photo: Flickr / H Dragon
Long-term surgical revision rate for obese patients is nearly double that for non-obese patients
Obese patients should be informed of risks before undergoing orthopaedic surgery

Obese patients have a greater risk of complications following total knee replacement surgery, including post-surgical infections, according to a review published in the Journal of Bone and Joint Surgery.

The study found that obese patients have double the rate of infection following total knee replacement surgery, compared with non-obese patients, and that the rate of infection is higher for both superficial and deep infections. As a consequence of these complications, the long-term surgical revision rate for obese patients is nearly double that for non-obese patients.

"Orthopaedic operations can technically be more difficult in obese people, and it is important for us to know whether there is a higher complication rate in the obese, and if the long-term outcome is worse," said Gino Kerkhoffs, an orthopaedic surgeon at the Academic Medical Center Amsterdam, University of Amsterdam, and lead author of the study.

A search of the literature was performed, and studies comparing the outcome of total knee arthroplasty in different weight groups were included.  A literature search identified 20 studies that were included in the data analysis.

The presence of any infection was reported in fourteen studies including 15,276 patients (I2, 26%). Overall, infection occurred more often in obese patients, with an odds ratio of 1.90 (95% confidence interval [CI], 1.46 to 2.47). Deep infection requiring surgical debridement was reported in nine studies including 5061 patients (I2, 0%). Deep infection occurred more often in obese patients, with an odds ratio of 2.38 (95% CI, 1.28 to 4.55).

Revision of the total knee arthroplasty, defined as exchange or removal of the components for any reason, was documented in eleven studies including 12,101 patients (I2, 25%). Revision for any reason occurred more often in obese patients, with an odds ratio of 1.30 (95% CI, 1.02 to 1.67).

The paper's authors advise that knee replacement surgery not be withheld from obese patients, but patients should be well-informed of the likelihood of complications following their total knee replacement, and advised to lose weight before surgery. Orthopaedic surgeons should be prepared to refer them to medical weight-loss professionals, if necessary. The authors also note that weight loss could lessen some patients' osteoarthritis symptoms.

"These results are not really surprising," said Kerkhoffs. “For the obese patient, this literature sheds new light on treatment options for symptomatic knee osteoarthritis, a total knee replacement is not the easy solution.”

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