Fate of the Morbidly Obese Patient Who Is Denied Total Joint Arthroplasty

• Published in: The Journal of arthroplasty 2020-06, Vol.35 (6), p.S124-S128
• Main Authors: Shapiro, Joshua A., Narayanan, Arvind S., Taylor, Patrick R., Olcott, Christopher W., Del Gaizo, Daniel J.
• Format: Article
• Language: English
• Subjects: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; denial; Humans; Knee Joint - surgery; morbid obesity; Obesity, Morbid - complications; Obesity, Morbid - surgery; patient-reported outcomes; Postoperative Complications; Retrospective Studies; total hip arthroplasty; total knee arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2020.01.071

The purpose of this study is to investigate outcomes of patients denied total hip (THA) or knee arthroplasty (TKA) due to morbid obesity. We performed an observational study of patients denied arthroplasty due to morbid obesity. A survey including the Harris Hip Score or pain and function components of the original Knee Society Score (KSS) was conducted with minimum 2-year follow-up. Statistical analysis was performed with parametric testing with significance at P < .05. In total, 125 (4.4%) of 2819 patients were denied THA or TKA due to morbid obesity. Twenty-four (19.2%) met target weight and underwent arthroplasty at our institution. Of the remaining 101 (80.8%) patients, 33 (32.7%) agreed to participate in the survey. None received THA and 6 received TKA elsewhere above target body mass index. Harris Hip Score was significantly higher in the successful weight loss cohort at our institution (70.5 ± 13.4 vs 34.6 ± 13.1). KSS Pain (maximum score of 50) and Function (maximum score of 100) were significantly higher in the successful weight loss cohort at our institution (32.9 ± 16.5; 51.1 ± 19.5) compared to the denied nonoperative cohort (7.2 ± 11.5; 33.0 ± 23.1); however, only KSS Pain was higher when compared to the TKA elsewhere cohort (14.2 ± 18.0; 29.2 ± 38.7). KSS Pain and Function were similar for both denial cohorts regardless of undergoing arthroplasty. Nearly 80% of patients denied never met target weight for arthroplasty. Those who met target weight prior to arthroplasty often reported better outcomes. Outcomes were similar when target weight was not met regardless of undergoing arthroplasty.