Obese patients undergo a disproportionately higher number of elective orthopedic surgeries in the U.S. Being fat is linked to higher costs, complications, infections and, in total knee and hip replacement surgeries, revisions. What is its impact on total shoulder arthroplasty (TSA) surgery?
A new study looked at the impact of obesity on both the costs and the outcomes of total shoulder arthroplasty surgery. Lead study author Xinning Li, M.D. said, “Our study found that with short-term follow-up, obesity does not have a detrimental effect on functional outcomes and complication rates in patients after TSA” He added, “In the normal body mass index (BMI) patient group, both the shoulder function and the overall physical function improved after TSA. However, among patients diagnosed with obesity, we found that the shoulder function improved after TSA, but the overall physical function did not improve at final follow-up.”
The study involved 76 shoulder arthroplasty patients who the researchers grouped according to their body mass index. They classified one group of 26 patients as “normal, ” a second group of 25 as “overweight” and a third group of 25 as “obese. They recorded preoperative demographics and complications during and after surgery and also assessed the patients before the surgery and at two years following.
The assessments were done using the American Shoulder and Elbow Surgeons (ASES) questionnaire for pain and function and the Physical Component Summary (PCS) Short Form-36. The study results found that pain diminished comparably in all weight groups at two years post-surgery from a score of 62 to 12 in the normal weight group, 68 to 18 in the overweight group, and 66 to 11 in the obese group.
There was one infection among patients who were overweight that required surgical intervention, and two surgical revisions in the normal weight group. In the normal weight group, the mean ASES scores increased from 38.4 preoperatively to 80.2 at two years post-surgery. The PCS score increased from 38.3 points preoperatively to 53.7 points at two years post-surgery.
In the group with patients who were overweight, ASES scores increased from 37.4 points to 75.2; PCS scores increased from 36.1 points to 39.8. In the group diagnosed with obesity, ASES scores increased from 35.8 to 80 and PCS scores increased from 36.3 to 40.7.
“This data suggests that in the normal BMI patient group who are active, that their overall physical function may have been limited due to shoulder pain, ” said Li. “Therefore, a total shoulder replacement was able to provide this patient population (normal BMI) with improved shoulder function which resulted in a better physical function. Total shoulder arthroplasty is an excellent procedure for pain relief and functional improvement in patients with shoulder arthritis, ” he said.
