CORRInsights®: Obesity Epidemic: Is Its Impact on Total Joint Arthroplasty Underestimated? An Analysis of National Trends

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Few issues within adult reconstruction have received as much attention in the past few years as obesity. There is little disagreement about the basic premise that as a patient's weight goes up, so too does the risk of complications after arthroplasty surgery. However, far less clear is what to do about this problem. The debate regarding how to manage obesity in the joint replacement population encompasses important ethical, political, and social issues. The move toward value-based care and bundled-payment models has only increased the intensity of this debate.
The study of obesity and its impact on total joint arthroplasty outcomes is complex. Obesity is associated with numerous medical comorbidities and socioeconomic factors that can adversely impact outcomes following total joint replacement. Stripping out the confounding variables in an attempt to tease out the inherent risk of obesity is challenging. Research using matching has suggested that although obesity is associated with complications following TKA, the independent impact of obesity as an isolated variable appears to be fairly modest [1]. It is also important to recognize that research has suggested an association between obesity and outcomes; a direct causal relationship between obesity and complications, if it exists, has yet to be established.
In the present study, George and colleagues studied the association between the increasing prevalence of obesity on primary, revision, and infected total joint arthroplasty in the United States. Their mathematic models suggest that the increasing prevalence of obesity is associated with an increased infection and revision burden.

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