Saturday, November 9, 2013

Does obesity affect the outcome of shoulder arthroplasty?

Functional Outcomes After Total Shoulder Arthroplasty in Obese Patients

We are increasingly recognizing the importance of PATIENT characteristics in determining the results of reconstructive surgery (the 4Ps = Problem, Patient, Procedure and Physician). Of these patient characteristics is obesity. The body mass index of patients is commonly classified as: normal (BMI  <25 kg/m2), overweight (BMI from 25 to 29.9 kg/m2 ) and obese (BMI  ≥30 kg/m2).

These authors evaluated the improvement in the The American Shoulder and Elbow Surgeons score, Short Form-36, and visual analog scale pain and fatigue scores at two years after total shoulder arthroplasty. 

For patients with normal BMI, ASES score improved from 38.4 ± 15.5  to 80.2 ± 19.4. 
The  SF-36 Physical Component Summary score improved from 38.3 ± 6.5 to 53.7 ± 11.3.
The VAS pain score decreased from 62 to 12.

In the overweight group, ASES score improved from 37.4 ± 18.1  to 75.2 ± 24.9 
The SF-36 Physical Component Summary score improved from 36.1 ± 8.0  to 39.8 ± 12.2.
The VAS pain score decreased from 68 to 18.

In the obese group, ASES score improved from 35.8 ± 12.5 to 80.0 ± 20.6.
The SF-36  Physical Component Summary score improved from 36.3 ± 8.4 to 40.7 ± 12.4 .
The VAS pain score decreased from 66 preoperatively to 11.

There was one deep infection in the overweight group that required surgical irrigation and debridement. Two revisions of the components were required in the normal group.

The authors concluded that obesity did not have a detrimental effect on the improvement of shoulder function.

Comment: what is interesting here is that in obese patients, improvement in self-assessed shoulder comfort and function did not correlate with a significant improvement in overall self-assessed physical function. This suggest that the overall physical function of obese patients with shoulder arthritis is limited by other factors in addition to the arthritis of the shoulder.

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