One in ten of those who receive artificial hips in Europe is obese – but the risk of complications increases with weight, a European conference has heard.
Professor Sébastien Lustig, from Croix-Rousse University Hospital in Lyon, France, told delegates at the 17th Congress of the European Federation of National Societies for Orthopaedics and Traumatology (EFORT) in Geneva, Switzerland, that medically, it is sensible to implant an artificial hip even in an extremely obese person.
“It is an effective way to re-establish the mobility of individuals with serious cases of arthrosis. Otherwise, the alternatives would be: chronic pain, disability and even the need for nursing care,” he said.
This is despite the findings of a Swiss study that people with a body mass index (BMI) of 35kg/m² and up have twice as many revisional surgeries compared to those who are not obese and suffer from serious infections twice as often.
Professor Lustig said: “Obesity is not just a biomechanical problem but also a biological one. It is true that every pound of joints bearing body weight is subject to a load of four to six pounds. Yet the effect of being overweight is much more complex and always has to be kept in mind in orthopaedic surgery.”
Diabetes, one of the typical co-morbidities of obesity, increases the risk of infection in hip replacement surgeries by 10%, so it is important that this condition is treated effectively before surgery goes ahead.
Other important actions to avoid infection include stopping smoking, special preparation of the skin and the use of bone cement with antibiotics, particularly if the patient is severely obese.
Professor Sébastien Parratte from Aix Marseille University in Marseille, France, told delegates that although there is no official weight limit for the implantation of prosthetic joints, patients with a BMI of 40 kg/m² and over should be advised to lose weight before they have surgery.
“The surgeons should therefore sit down with the patients and go through all risks that might occur if they fail to lose weight prior to surgery,” he said. “Moreover, the possible ways of reducing weight should be discussed – if necessary also surgical options such as gastric banding.”
As the number of obese individuals needing joint replacement will increase in the future, special surgical techniques could become established, said Profs Lustig and Parratte, including the use of tailor-made patient-specific templates as a guide when putting prostheses in place.
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