Saturday, August 8, 2015

Total shoulder arthroplasty - relationship of complications to obesity

Superobesity (body mass index >50 kg/m2) and complications after total shoulder arthroplasty: an incremental effect of increasing body mass index

Different degrees of overweightness are classified as nonobese (BMI < 30), obese (BMI 30-39.9), morbidly obese (BMI 40-49.9), and superobese (BMI 50 or more) These authors identified 144,239 patients who underwent TSA or reverse TSA in the PearlDiver database and then divided them into non obese (105,661), obese (23,864), morbidly obese (13,759), and super obese (955) cohorts.

Superobese patients had a significantly higher rate of infection, dislocation, component loosening, revision shoulder arthroplasty, venous thromboembolism, and medical complications after shoulder arthroplasty compared with nonobese controls.

Comment: The authors point out that the prevalence of obesity in the United States continues to increase. During the past decade, the percentage of obese adults in the United States has increased by 129%, with more than a third of the adult population having a body mass index (BMI) >30 kg/m2. By the year 2030, 90% of Americans will likely be overweight and 50% will be obese.

These data indicate that it is more risky and more expensive to perform shoulder arthroplasty on heavier patients. While these patients can have severe pain and functional limitations from their shoulder arthritis, surgeons need to decide at what point surgical intervention is not in the best interest of the patient or of the society in which they live.


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