BOSTON, Mass—As the epidemic of obesity collides with the skyrocketing rates of joint replacement surgery, orthopaedic surgeons will need to brush up on skills to better manage obese patients, according to Timothy Bhattacharyya, MD, an instructor of orthopaedic surgery at Harvard University Medical School and orthopaedic surgeon with Partners Orthopaedic Trauma Service at Massachusetts General Hospital and Brigham and Women's Hospital in Boston and Daniel Guss, MD, an orthopaedic surgery resident at Harvard, in the July 2006 issue of the Journal of the American Academy of Orthopaedic Surgeons.

Despite the fact that these surgeries are more technically difficult, of longer duration, and have higher rates of risks and complications, obese patients can, and do, undergo virtually all orthopaedic surgeries.

"Obesity is an epidemic that we are dealing with, and unfortunately, losing weight before surgery is difficult," Dr. Bhattacharyya told CIAOMed. "Even after joint replacement surgery, people tend not to lose very much weight, so all we can do is counsel our patients appropriately to [help] them understand that if they are obese, they are at higher risk of infection [and] pulmonary embolus, and they have to be aware of these things."

Obese patients use approximately 40% more cardiovascular (CV) energy than patients of average weight, and this increases the risk of CV mortality and death. Preoperative evaluation should focus on cardiopulmonary status, and risk stratification should seek to identify any modifiable conditions, the researchers wrote. All obese patients should undergo electrolyte and glucose testing and have a complete blood count. When patients are also diabetic, renal function should be assessed, they added. Electrocardiogram and chest x-ray are also helpful for obese patients before surgery.

Preparation on the part of the surgeon must also play a role, Dr. Bhattacharyya said. "We will need specialized equipment, specialized hospital beds, and adequate preparation, including an extra assistant in the operating room," he told CIAOMed. Other techniques and countermeasures can help surgeons better manage potential complication of orthopedic surgeries among obese patients. For example, maintaining position in hip arthroplasty patients can be difficult but bean bags, hip positioners, and peg boards can help. Sufficient padding is also needed to avoid neuroplaxias.

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