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Obese patients have higher infection rates,
complications after TKA surgery
October 24, 2012
ROSEMONT, IL – Obese patients have a greater risk of complications
following total knee replacement surgery, including post-surgical
infections, according to a new literature review recently published
in the Journal of Bone and Joint Surgery (JBJS). Because of
complications, obese patients are more likely to require follow-up
surgery (revision).
Obesity is reaching epidemic proportions, particularly in the United
States, and is a well-documented risk factor for the development of
osteoarthritis. Arthritis is initially treated nonsurgically, but
total joint replacement often becomes necessary if the disease
progresses. Consequently, the rate of joint replacements in obese
individuals has increased in the last several decades.
"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," says Gino M.M.J. Kerkhoffs, MD, PhD, an orthopaedic surgeon
at the Academic Medical Center Amsterdam, University of Amsterdam,
and lead author of the study.
Findings include:
• Obese patients have double the rate of infection following total
knee replacement surgery compared to non-obese patients.
• Obese patients' rate of infection is higher for both superficial
and deep infections.
• The long-term surgical revision rate for obese patients is nearly
double that for non-obese patients.
The paper’s authors advise that knee replacement surgery not be
withheld from obese patients. Rather, obese 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.
"Although these results are not really surprising," Kerkhoffs says,
"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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