Obesity worsens outcomes of joint surgery

After undergoing joint replacement or repair, people who are obese - or have high blood pressure or Diabetes - don't do as well as others without these conditions, a new study shows.

Obesity especially increases the likelihood of "in-hospital post-operative complications and patient transfer to a rehabilitation facility" after shoulder, hip and knee surgery, said Dr. Nitin Jain from Duke University Medical Center in Durham, North Carolina.

Jain and his associates investigated the impact of various health conditions on the complication rate among nearly 1 million patients who underwent surgery to repair or reconstruct a shoulder, hip or knee.

Post-operative complications were more common in patients with obesity (3.7 percent), Diabetes (2.9 percent), or high blood pressure (2.8 percent) than in patients with none of these conditions (2.6 percent), the authors report in the journal Clinical Orthopaedics and Related Research.

After accounting for other factors, obesity still conferred a 30 percent greater risk of complications after surgery, according to the team.

The need for additional treatment after discharge from the hospital was significantly more common in patients with obesity and among patients with both obesity and Diabetes.

Although the differences in complication rates between people with and without these other health conditions seems relatively small, "the absolute impact on the patient population undergoing (joint surgery) every year is clinically very relevant," the investigators write.

"These differences become even more important," they note, as more and more people undergo joint replacement procedures every year, and because of "the alarming rise" in the prevalence of obesity, Diabetes, and high blood pressure.

"The risks/benefits of the procedure" for people with these conditions "should be decided on an individual patient basis by the surgeon and the patient," Jain said.

SOURCE: Clinical Orthopaedics and Related Research, June 1, 2005.