Nutritional Counseling Program for Morbidly Obese Patients Enables Weight Optimization for Safe Total Joint Arthroplasty

摘要

Obesity affects one-third of total joint arthroplasty (TJA) patients and is the most common modifiable risk factor for increased complications in the TJA population.The authors' institution implemented a body mass index (BMI) cutoff of40 kg/m(2) to define appropriate TJA candidates. Patients above the cutoff were referred for nutritional counseling. The study objective was to evaluate the efficacy of this protocol in optimizing patient BMI for safe and successful TJA. Between 2016 and 2018, the authors examined 133 patients (mean age, 62.6 years) with a BMI greater than 40 kg/m(2) seeking TJA (94 knee, 39 hip) seen by an arthroplasty surgeon and then a dietitian. Outcomes included weight loss,change in BMI, duration of counseling, and surgical status. For postoperative patients, 90-day complications were recorded. A total of 102 (92%) patients achieved weight loss during a mean 154 days (range, 8-601 days). Patients lost a mean of 17 Ib, lowering their BMI by 2.7 points (range, +6.3 to -17.7 points). Twenty-two patients discontinued nutritional counseling after 1 visit, most commonly secondary to cost when not covered by insurance. Seventy-one patients successfully underwent TJA, representing 64% of those patients who participated in nutritional counseling. Complications included delayed wound healing (n=2), periprosthetic fracture (n=2), infection (n=1), cellulitis(n=1), and peroneal nerve palsy (n=1). Surgeons must actively counsel obesepatients about weight optimization as part of the preoperative standard of care. Nutritional counseling with a dietitian and follow-up with the surgeon translated to safe and successful TJA in a majority of patients.