Scientists say individuals who undergo joint surgery for arthritis, such as joint replacements, in the years following surgery if they are obese will probably become dependent.
Further research is needed to know why this happens and how to prevent it, the research group writes in British Journal of Anesthesia.
“I think there’s been a lot of research on mortality and a lot of research on complications, however not all that much on how individuals really get back to how they perform at home,” lead author Dr. Timothy Gaulton said.
Gaulton, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, said, “That was a part of the reason that we needed to take a look at the result and in general obese patients”.
That is a few conditions it’s important for potential joint surgery patients to know, as a result of their age, weight or preoperative functional dependence, they might be at higher risk of getting worse after surgery, he said in a telephone interview.
“It’s something that should be considered as both for the patient and for the surgeon when they make this decision about moving ahead with getting a joint surgery,” he said. The researchers studied 2,519 adults over age 61 who had joint surgery for arthritis.
Around 66% of members had joint replacements. And 45 percent were obese, which means they had a mass index (BMI) – a measure of weight relative to the height of 30 or above at the time of their surgery. Before surgery and during the following two years, members were asked whether they had any physical, mental, emotional or memory issues that affected their activities of daily living.
These activities could include things like getting out of bed, toileting, showering and eating. Requiring help for any of these tasks was labeled as a dependence disability.
Around 22 percent of members reported new or worsening dependence approximately two years after their surgery including more than one of every four obese patients and one out of five non- obese patients.
Scientists determined that obese joint replacements patient had around 35 percent higher risk of dependence after surgery compared with non- obese patients.
Gauton said, “We weren’t surprised by the association between obesity and results, but I think we were surprised that the percentage of patients who had a disability after surgery was so high. It wasn’t only obese patients; I think it was elderly patients in general”.
Doctors may need to give careful consideration to, and possibly counsel, not just obese patients but rather elderly patients in general.
“They come in for surgery and an expectation of showing signs of improvement. That may not always be the case,” he said.
Note that improvement was seen for most obese and non- obese members, said Dr. Michael Parks, an orthopedic surgeon with the Hospital for Special Surgery in New York City who wasn’t associated with the study.
“Along these lines, the point is, joint surgery is helpful something other than replace their joint whether patients are obese or not, but rather it shows that we have to help out them,” Parks said in a phone interview.
“Something that we do here at HSS, and that I hope is becoming more common nationally, is we work collaboratively with our medical colleagues to try to address obesity
It’s also important for patients to become involved with their own health care, Parks included.
“Regardless of whether you go to your primary care doctor, whether you go to a nutritionist, whether you go next door to a center for weight reduction that is medical or whether you go to our center for weight reduction that is surgical, the point is, become associated with your health and do something to lose weight to improve yourself a better candidate since that has implications on your surgical result, your risk, and this study demonstrates that it has a long term result of your dependence and your ability to be independent and your mobility,” he said.
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