OKOJ

OKOJ, Volume 11, No. 6


Anesthesia Management in Obese Patients Undergoing Total Joint Replacement

The multisystem changes associated with obesity present unique challenges to the orthopaedic surgeon and anesthesiologist, with implications for general anesthesia, neuraxial blockade, postoperative analgesia, and management of perioperative systemic complications. Current knowledge about the challenges associated with anesthesia in obese patients is largely derived from nonorthopaedic literature. Though the general principles of anesthesia may be applicable to the arthroplasty population, well-designed trials specifically evaluating the impact of obesity on anesthetic challenges and perioperative systemic complications in patients undergoing total joint replacement are needed. This article reviews the risks associated with anesthesia in obese patients undergoing total joint replacement, and outlines techniques to improve postoperative pain management in these patients.

    • Keywords:
    • obesity

    • anesthesia risks

    • general anesthesia

    • regional anesthesia

    • total joint replacement

    • pain management

    • Subspecialty:
    • Adult Reconstruction

Guest Editorial: The Impact of Obesity in Lower Extremity Total Joint Arthroplasty

Obesity complicates lower extremity joint reconstruction in numerous ways. In this special issue of Orthopaedic Knowledge Online Journal and a forthcoming issue, we will focus on the problems of obesity in the setting of first total hip arthroplasty and then total knee arthroplasty. We will examine the sources of complications associated with obese patients undergoing lower extremity joint replacement, and discuss current methods for preventing or mitigating these problems. Surgical techniques and preoperative management of these patients will also be described.

    • Keywords:
    • obesity

    • joint replacement

    • complications

    • outcomes

    • Subspecialty:
    • Adult Reconstruction

Obesity and Periprosthetic Joint Infection

With the rising prevalence of obesity in the general population, the role of obesity in predisposing to periprosthetic joint infection has come under scrutiny. Obesity adversely affects the immune system, creates an unfavorable local tissue environment at the surgical site, prolongs surgical time, impairs the delivery of antibiotics, and has been postulated as a risk factor for periprosthetic joint infection. This article examines the mechanisms through which obesity plays a role in periprosthetic joint infection, reviews the studies that have attempted to delineate this association, and explores options for prevention in the obese total joint arthroplasty patient.

    • Keywords:
    • obesity

    • body mass index

    • BMI

    • total joint athroplasty

    • total hip arthroplasty

    • total knee arthroplasty

    • periprosthetic infection

    • infection

    • inflammation

    • pulsatile lavage

    • vacuum-assisted wound closure

    • polymorphonuclear bactericide

    • bariatric surgery

    • Subspecialty:
    • Adult Reconstruction

Obesity and the Risk of Venous Thromboembolism in Total Joint Arthroplasty

Patients undergoing total hip or knee arthroplasty have a varying risk of developing venous thromboembolism during the perioperative period, and factors such as obesity have been recognized to increase this risk. In general, the risk of venous thromboembolism in obese patients is considerable. Estimates from 2007 through 2010 suggest that more than one third of adults in the United States are obese (BMI >30 kg/m) and 1 in 20 is morbidly obese (BMI >40 kg/m). Specific obesity-related issues continue to challenge the joint replacement surgeon, including management of venous impairment and the appropriate use of pharmacologic prophylaxis before and after surgery. In addition, obese patients may require a longer stay in the hospital, longer surgery, and are more likely to be readmitted to the hospital than nonobese patients. All members of the health care team should be aware of the special needs of these patients in order to maintain their quality of care.

    • Keywords:
    • obesity

    • total joint arthroplasty

    • venous thromboembolism

    • deep vein thrombosis

    • pulmonary embolism

    • low-molecular-weight heparin

    • warfarin

    • Virchows triad

    • metabolic syndrome

    • Subspecialty:
    • Adult Reconstruction

The Impact of Obesity on Total Joint Arthroplasty

With an increasing demand for arthroplasty in younger and heavier patient populations, surgeons should be prepared to safely treat this challenging group. Every aspect of the care of an obese patient is more challenging than that of a patient of normal weight, and the outcomes are often inferior. The risk of complications of arthroplasty increases when the body mass index (BMI) reaches 35 kg/m, and morbidly obese patients may be at substantially increased risk for complications requiring surgical intervention. Weight loss before arthroplasty should be encouraged, and patients should understand that the surgery is unlikely to result in weight reduction. Treatment options for obesity in patients who are candidates for arthroplasty include counseling, diet programs, medications, and bariatric surgery. Brief counseling and referral of these patients for appropriate treatment of their obesity can be an effective method of avoiding complications following surgery.

    • Keywords:
    • obesity

    • morbid obesity

    • diabetes

    • total joint arthroplasty

    • total hip arthroplasty

    • total knee arthroplasty

    • osteoarthritis

    • periprosthetic joint infection

    • body mass index

    • BMI

    • lymphedema

    • pedal pulse

    • venous stasis

    • capillary refill

    • weight counseling

    • weight loss medication

    • bariatric surgery

    • Subspecialty:
    • Adult Reconstruction

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