The first wave of Baby Boomers will turn 75 this year and even the youngest members of this group are edging ever closer to becoming sexagenarians. This generation represents more than 20 percent of the population and the wear-and-tear that comes with age will continue to show itself in health issues, notably orthopedic and musculoskeletal diseases.
Bone structural changes affect about half of the adult population over 50 years and the loss of density and osteoporosis increase with age. Obesity exacerbates the effects. Excess weight adds disproportionate stress to bones and causes soft tissue damage. Every pound of additional body weight adds four to six pounds of pressure on already aging knee joints.
Beyond bone degeneration, joints also become less flexible and the fluids that lubricate them become thinner or decrease, and cartilage in the knees and hips can deteriorate. Osteoarthritis (OA) is often associated with obesity, with overweight women having four times the risk and men having five times the risk for knee OA. Rheumatoid arthritis (RA) is also worsened by obesity. A long-term study confirmed this, and also noted that 10 years of being obese resulted in a 37 percent increase in risk of RA.
It is not surprising, then, that total joint replacement arthroplasties (TJA) are at high levels. Conservative forecasts suggest that by 2030, TJA will be in the range of 1.28 million, while at the same time the mean age for replacement is declining. Although these staggering numbers represent the total population, obesity is an established risk factor for TJA and patients with obesity are three times as likely to develop osteoarthrosis, thus the prevalence of patients with obesity undergoing primary and revision TJA is high.
Although surgery can offer relief, patients face continued challenges throughout and following the procedure. Patients with obesity already are more likely to have comorbidities that put them at higher risk for complications, and obesity is a strong independent risk factor for pain. They also experience more major medical and wound complications, 30-day readmissions, significantly longer lengths of stay and notably higher in-hospital costs — to the tune of $8,000 more for patients with morbid obesity.
Weight reduction is a strong pre-surgery recommendation. Monitored weight loss using meal replacements can benefit patients prior to surgery because they are safe and result in quick, short-term weight loss. This can have a positive impact on post-surgery results. Findings from a meta-analysis showed that participants on a partial meal replacement plan experienced significant weight loss and improvement in systolic blood pressure, triglycerides, and glucose levels. Patients with obesity who lose weight non-surgically also have better surgical and functional outcomes.
Physicians must recognize and address perioperative contributing factors that can improve patient care from diagnosis to discharge and beyond. As a first step, engagement and education can help address issues related to obesity as part of pre- and post-surgery rehabilitation, with the possible added benefit of continued weight reduction.