What are the implications of withholding total joint arthroplasty in the morbidly obese? A PROSPECTIVE, OBSERVATIONAL STUDY

Aims The aim of this study was to observe the implications of withholding total joint arthroplasty (TJA) in morbidly obese patients. Patients and Methods A total of 289 morbidly obese patients with end-stage osteoarthritis were prospectively followed. There were 218 women and 71 men, with a mean age of 56.3 years (26.7 to 79.1). At initial visit, patients were given information about the risks of TJA in the morbidly obese and were given referral information to a bariatric clinic. Patients were contacted at six, 12, 18, and 24 months from initial visit. Results The median body mass index (BMI) at initial visit was 46.9 kg/m(2) (interquartile range (IQR) 44.6 to 51.3). A total of 82 patients (28.4%) refused to follow-up or answer phone surveys, and 149 of the remaining 207 (72.0%) did not have surgery. Initial median BMI of those 149 was 47.5 kg/m(2) (IQR 44.6 to 52.5) and at last follow-up was 46.7 kg/m(2) (IQR 43.4 to 51.2). Only 67 patients (23.2%) went to the bariatric clinic, of whom 14 (20.9%) had bariatric surgery. A total of 58 patients (20.1%) underwent TJA. For those 58, BMI at initial visit was 45.3 kg/m(2) (IQR 43.7 to 47.2), and at surgery was 42.3 kg/m(2) (IQR 38.1 to 46.5). Only 23 patients (39.7%) of those who had TJA successfully achieved BMI < 40 kg/m(2) at surgery. Conclusion Restricting TJA for morbidly obese patients does not incentivize weight loss prior to arthroplasty. Only 20.1% of patients ultimately underwent TJA and the majority of those remained morbidly obese. Better resources and coordinated care are required to optimize patients prior to surgery.