Embedded Files
Obesity and Orthopedic Surgery According to the American Academy of Orthopedic Surgeons, obesity is a major contributor to many orthopedic conditions. 2 Genes Metabolism Behavior Socioeconomic Status Culture Environment 31.2% of Americans with obesity have been diagnosed with arthritis.4 Ligament disruption is more common in patients with obesity5 , and increased weight can activate mechanoreceptors in the cartilage. The increase of mechanoreceptors may create an overproduction of cytokines, growth factors, and more, which can cause chemical cartilage degradation.6,7 BMI Chart Obesity is a complex metabolic disease.1 However, the cost for a knee arthroplasty is 110% higher for a patient with obesity11, and obesity poses surgical risks that include12: 96% of surgeon respondents in a Canadian survey have delayed or declined to perform elective surgery in patients with a BMI higher than 38.13 increased risk of SSI increased risk of deep infection increased risk of implant revision 1.9X 2.38X 1.3X The need for total knee arthroplasty is 8.5X higher in patients with a BMI over 30 and 32Xin patients with a BMI over 40 than patients in a normal weight category.10 Patients with obesity are 3.8X more likely to develop symptomatic osteoarthritis than individuals with a normal BMI. They also have an increased likelihood for both a hip and knee replacement.8,9 With many national and regional commercial insurance companies placing BMI restrictions on joint replacement surgery, and programs such as CJR bundled payments placing increased scrutiny on costs and outcomes, many patients with a BMI of 40+ are being denied joint replacement surgery. Bone spurs Synovial fluid changes3 Eroding cartilage Eroding meniscus Lax ligaments One orthopedic surgeon stated that he turns away as many as 10% of his patients due to high BMI or diabetes.14 In most patients, sleeve gastrectomy and gastric bypass surgeries produce excess weight loss of +25% at 5 years.17 Bariatric surgery is used in morbidly obese adult patients for significant long-term weight loss. Results following bariatric surgery may vary. Bariatric surgery may be appropriate for some patients, and not for others depending on their specific weight, age, and medical history. HARACTERIZATION OF ORTHOPEDIC SURGEONS’ MEDICAL TOUCHPOINTS FOR PATIENTS WITH OSTEOARTHRITIS AND OBESITY A.E. Nelson 1 , D. Horn 2 , K. Earles 3 , S. Mathew 3 , C. Damsgaard 4 . 1 Thurston Arthritis Res. Ctr. and Dept. of Med. at Univ. of North Carolina, Chapel Hill, NC, USA; 2Dept. of Surgery and Ctr. for Obesity Med. and Metabolic Performance, Houston, TX, USA; 3Novo Nordisk, Inc., Plainsboro, NJ,USA; 4 Boston Orthopaedic and Spine, Boston, MA, USA Purpose: Obesity is a risk factor for osteoarthritis (OA) development and progression. Per American College of Rheumatology (ACR) guidelines, weight management is an important strategy for managing OA; however, it is often overlooked in treatment approaches. To understand the medical journey of patients with OA and obesity, interactions between patients and orthopedic surgeons were mapped to identify the roles involved, influential factors, and the process for treatment decisions. Methods: A cross-sectional study was conducted in the U.S. with healthcare providers (HCPs) and patients with OA and obesity. An initial series of qualitative interviews with patients and HCPs were performed to inform a robust quantitative survey. Participants were recruited from an online panel and completed an online survey in January 2020. HCPs included primary care physicians (PCPs), rheumatologists, orthopedic surgeons, nurse practitioners and physician assistants. This was an anonymous online survey; thus, institutional review board approval was not required. The survey was conducted in accordance with the principles and guidelines established by the Office for Human Research Protections and the Insights Association Code of Standards and Ethics. Results: Quantitative survey results from the patients and orthopedic surgeons are reported here. Respondents included 304 patients with OA and obesity and 104 orthopedic surgeons. Based on self-reported height and weight, patients were categorized as obesity class I, defined as a BMI of 30- Executive Summary Introduction Obesity and osteoarthritis are both chronic diseases with interconnected pathways of development and progression. The elevated prevalence of obesity and osteoarthritis has resulted in increased demand for health services and appropriate osteoarthritis treatment strategies, including a need for hip and knee surgical replacement earlier in the lifespan. This is challenging clinicians and health service delivery teams in appropriately determining care pathways and treatment options for osteoarthritis for patients with concurrent obesity. This is challenged further by few effective obesity treatments, limited resources for severe obesity management in Alberta, divided health care delivery pathways for obesity and osteoarthritis, and inadvertent weight bias. Purpose To meet these challenges and identify pragmatic
Google Sites
Report abuse