Obesity epidemic is having implications on orthopaedic patients too….

Published on: 17 June, 2014

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Over the past decade, there has been a lot said and written about the obesity epidemic. Initially we thought of ourselves as a fit and health nation, and it was the American’s with their fast food diet that led to their obesity problems. In 2014, the difference between the two nations in terms of rates of obesity, is not so great.

According to the Australian Institute of Health and Welfare, 3 out of 5 Australian’s are overweight or obese, based on BMI. That equates to 12 million people. 5% more of adults are overweight or obese than there was in 2005, and being overweight or obese is now third behind smoking and high blood pressure in contributing to the burden of disease. Excess weight, especially obesity, is a major risk factor for cardiovascular disease, Type 2 diabetes, some musculoskeletal conditions and some cancers. As the level of excess weight increases, so does the risk of developing these conditions.

A newly published study has now also shown that patients undergoing Total Knee Arthroplasty (TKA) are now older and heavier than they were 20 years ago, confirming the commonly known beliefs around our ageing population and increasing obesity levels. In this study, presented at the recent EFORT Congress, a retrospective analysis was performed of 6868 patients who underwent TKA between December 1994 and August 1998, and a second group of 1,408 patients who underwent surgery from January 2009 and November 2012.

The mean age at the time of surgery and body mass index (BMI) was significantly greater in the second group of patients. Interestingly though, changes in surgical practice over that time period has improved complications.

“The patients in the second group had an average BMI of 32.0 kg/m2, significantly higher than patients in the first group who weighed in at 29.4 kg/m2 on average,” lead author Ewan Barclay Goudie, MBChB, of the Victoria Hospital in Kirkcaldy, United Kingdom, stated in a press release. The first group however experienced greater length of stays, increased number of post-operative blood transfusions and worse and worse mean preoperative pain and function components of the American Knee Society Score, indicating an improvement in surgical technique over the years.
The 2013 Supplementary report of the National Joint Replacement Registry (NJRR) reports that the median age for a TKA in Australia is 69 years of age. With this data collected since the registry was implemented in 2002, it would be interesting to see if there have been any significant increases in median age or BMI (data not collected by the NJRR) over that period. Given the trend of Australian’s following our American counterparts in obesity levels, it would seem very likely.
Reference: Goudie EB. Abstract #839. Presented at: 15th EFORT Congress: a combined programme in partnership with BOA; June 4-6, 2014; London.

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