Faculty Bibliography

INTRODUCTION/BACKGROUND:As total hip arthroplasty and total knee arthroplasty procedures are increasingly performed on younger patients with obesity, the optimal approach to preoperative weight management remains undefined. This study explores national trends among US arthroplasty surgeons regarding body mass index (BMI) cutoffs, weight optimization strategies, and weight loss medication usage. METHODS:A 28-question national survey was distributed through e-mail to members of the American Association of Hip and Knee Surgeons and shared on professional social media platforms (Facebook, ResearchGate, and LinkedIn) between January 1 and August 5, 2024. RESULTS:Regarding arthroplasty reconstruction fellowship training, 82.58% (441/534) of respondents were fellowship trained, 11.42% (61/534) were not fellowship trained, and 5.99% (32/534) trained in other specialties. In terms of BMI optimization strategies, 82.84% (n = 444/536) recommended structured diet and exercise programs, 77.99% (n = 418/536) recommended dietitian or weight loss specialist programs, and 52.61% (n = 282/536) advocated for bariatric surgery. For total hip arthroplasty, 45.13% of surgeons used a BMI cutoff <40 kg/m2 (n = 241/534), followed by 23.97% advocating for no strict cutoff (n = 128/534). For total knee arthroplasty, 41.65% reported using a cutoff of <40 kg/m2 (n = 222/533), with 24.39% (n = 130/533) reporting no strict BMI cutoff. In addition, 27.62% (n = 58/210) reported that their patients used weight loss medications such as GLP-1 agonists. Notably, 68.0% (n = 356/526) of surgeons allowed up to 1 to 2 years for BMI optimization before surgery. CONCLUSION/CONCLUSIONS:Although many arthroplasty surgeons use BMI cutoffs, many accommodate patients through nonsurgical interventions to facilitate weight loss. These findings indicate that many respondents report a multidisciplinary approach to preoperative BMI optimization.

BACKGROUND:Diabetes mellitus has been associated with significant perioperative complications in joint arthroplasty. In addition, many patients are unaware of their dysglycemic status, and the prevalence of undiagnosed dysglycemia in joint arthroplasty patients is unknown. METHODS:Several years ago, we began routine hemoglobin A1c (HbA1c) level screening in all our patients planning to undergo elective total hip and total knee arthroplasties. We retrospectively reviewed the HbA1c levels in our initial 663 patients. RESULTS:Forty-eight percent of these patients were found to be nondiabetic; 19% percent had a previous history of some level of dysglycemia. Most significantly, over one third, 33.6% of these patients were previously undiagnosed dysglycemic patients; 31% were diagnosed as prediabetic and 2.6% as diabetic. CONCLUSION:Owing to the high prevalence of prediabetic patients who go on to develop diabetes and to the high correlation of poor glucose control with perioperative complications, we feel that it is imperative to identify this large number of previously undiagnosed dysglycemic patients. We recommend the routine screening of all patients planning to undergo major orthopedic procedures. Likewise, we recommend that identified patients be referred for diabetic counseling. We also recommend that patients with markedly elevated HbA1c levels have their elective surgery postponed until better glycemic control can be achieved.