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Obesity Day and prosthetic surgery: 3 times more likely in patients who are overweight and obese than 9
In sharp increase in cases of arthritis and joint replacement early in the obese patients. To explain is Giorgio Maria Calori primary orthopedic Pini Orthopaedic Institute in Milan, analyzing the reasons, complications and services.
Milan, October 7, 2014 - Obesity has been recognized as a multifactorial disease that more often found associated with other diseases: diabetes mellitus type 2, bone and joint disease, sleep apnea syndrome, the psychiatric problems and psychological disorders caused by the family and / or social environment in which the patient lives and endocrine diseases.
In the United States, epidemiological studies show that 1 in 3 is obese resulting in a cost of 100 billion dollars in health care costs due also to a longer hospital stay. The incidence of this patient population has tripled since 1970.
"More and more frequently in our series orthopedic, in the wake of the United States, we have had an increase in obese patients - said Giorgio Maria Calori, Director of the Division of Orthopaedic Surgery, Restorative (COR) Gaetano Pini Orthopaedic Institute of Milan - The trend of hospitalization of these patients is constantly growing. With the increase in obesity has found an increase of osteoarthritis, and therefore a growing number of patients is forced to use a prosthetic replacement early ".
Clinical studies have shown that in patients with BMI * greater than 30 kg / m2 have an incidence of 9.3 times to develop a high gonarthrosis. In patients with simple overweight, however, already 3 times. The prosthetic surgery in the obese patient is a major challenge to the orthopedic surgeon because of numerous problems and complications that can meet these patients who present in 30% of cases, series co-morbidities, ie coexistence pathological: quadriceps deficits, increased risk of infection to 15 times larger in obese, hyperalgesia, an increased risk of mobilization of the plant resulting in the need for subsequent revision surgeries. All this translates into a lower patient satisfaction that often hesitates a pain front.
"The most sensitive issue is the increased risk for septic. In fact, in these patients we find risk factors such as a decrease in the immune system, a state of insulin resistance and in some cases co-existing diabetes mellitus type 2. A particular complication that occurs frequently in prosthetic surgery of the knee tibial osteolysis, phenomenon which is accentuated over 5 times in patients with a BMI greater than 40 kg / m2. - Continued Heats - The surgeon should also pay attention to the risk of malalignment, internal rotation, and particularly in the treatment of soft tissue above. The obese patient must be accompanied step by step in the course of treatment by qualified personnel able to meet all the needs and attentions of this delicate surgery both in the pre, peri and post-operative.
It is clear, therefore, that this type of surgery to be performed in centers superspecialistici where the patient is managed with an appropriate multi-disciplinary approach, where there is medical staff specially trained and organized in accordance with the specific therapeutic needs, networking with other centers of excellence in Italy and abroad. All this with the sole intent to achieve the best clinical outcome, by giving this type of "patient at risk" the best quality of care in a primary consideration of security.
* The BMI is a value that defines overweight patient with a BMI between 25 and 30 kg / m2, obese when recording a BMI between 30 and 40 kg / m2, obese large when the value is between 40 and 50 kg / m2 , super obese with a BMI greater than 50 kg / m2.
