Should patients be denied access to total joint replacement surgery because they are obese?

Abstract

Since 1990 The World Health Organisation (WHO) has raised concerns about increasing rates of obesity in both children and adults. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings. WHO defines individuals who have a BMI between 25-29.9 as overweight and a BMI of 30 or over as obese. Obesity is subdivided into 3 classes: class 1 BMI 30-34.9, class 2 BMI 35-39.9 and class 3 BMI of 40 or over. Overweight and obesity are major risk factors for a number of chronic diseases including diabetes, cardiovascular and cancer. In our speciality the impact of overweight and obesity on development of osteoarthritis in load bearing joints is well documented. Increasing numbers of people with severe OA of the knee joint requiring TKR is a global challenge in the developed world with TKR in-patient costs exceeding $9 billion in 2008 in the USA alone- the highest aggregate cost among the ten procedures for which demand is growing fastest. Between, 2005-2030 the demand for primary TKR in the US is projected to grow by 673% or 3.48 million procedures annually (Tomek et al, 2012).