New strategies to improve knee replacement outcomes in obese patients

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New recommendations suggest testing patients for nutritional deficiencies could improve postoperative outcomes.

Prior to undergoing total knee replacement (TKR) surgery, obese patients should be tested for nutritional deficiencies, as obesity is often associated with malnourished and hypoalbuminaemia, an independent risk factor for poor outcomes after TKR.

That’s according to a review published in the  Journal of the American Academy of Orthopaedic Surgeons (JAAOS), which has identified strategies to improve TKR outcomes in patients with obesity.

Other preoperative considerations should include optimisation of nutritional status, safe weight loss strategies, and bariatric surgery, according to the review. Excess soft tissue in patients with obesity can obstruct visibility during surgery. This lack of visibility can result in difficulty achieving proper alignment and implant fixation as well as longer surgical time. Techniques such as computer-assisted alignment may expedite surgery, and minimise complications, the authors advised.

Postoperative issues to be considered include tibial loosening, wound complications, cardiovascular events, and respiratory complications.

“Although further research is needed, this review has allowed us to identify a variety of treatment methods to improve outcomes and reduce complications in patients with obesity,” said lead study author and orthopaedic surgeon Dr J. Ryan Martin.


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