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Obesity and Musculoskeletal Care
AhmedAlqatub4thyearICMS
Background • nega6velyaffectsorthopaedic.• 1.5Boverweight&500Mwereobese.• Overweight25-29.9• Obese30orhigher• expandingperspec6vesontreatmentop6onsandchallengesurgicalskills.
• burdenofobesityissignificantonavarietyofoutcomemeasuresincluding:• infec6onrisk,• non-union,• persistentpain,• cost,andimplantfailure.
Co-Morbid Condi8ons and Peri-Opera8ve Management
• diabetes,• coronaryarterydisease,• deepveinthrombosis,• pulmonaryembolus,• malignancy,• obstruc6vesleepapnea,andasthma.
Individualized anesthe8c Plan
• peri-opera6veperiod,prematuredeath• Anesthe6cintuba6onwithafiber-op6c.• Regionalanesthesia.
• well-paddedtablesandboards:• Pressureulcera6ons,nervepalsies,andcompartmentsyndromesmorereadilyoccurinobesethannon-obeseindividuals• Nursingcare.
Total Joint Arthroplasty
• Obesityhasadirectresultonthedevelopmentofosteoarthri6softhehipandkneejoints.• TheneedforhavingaTKR• 8.5%mesBMI>30,• 18.7%mesBMI>35,• 32.76mesBMI>40.
• BMI>40appeartohaveevenhighercomplica6on.
TKR
• hashigherrisksofinfec6on,• increasedbloodloss;• woundrelatedproblems,• avulsionofthemedialcollateralligament,• componentmalposi6oning,• extensormechanismrupture,• andpatellarmaltracking.
• Thesecomplica6onratesalsoincreaseastheBMIincreases.• Inmedialunicompartmentalarthroplasty:• componentloosening,• failure,• andfracture.
THR
• Thereappearstobeevidencethatobesityhasadirectassocia6onwith:• infec6onrates.• higherrisksforhardwaremalposi6oning,• thromboembolicevents,• higherbloodloss,• loosening,infec6on,andul6mately,catastrophicfailure.
Pediatrics
• Blount'sdisease• increasedriskforgenuvalgumandrecurvatum.• Slippedcapitalfemoralepiphysis(SCFE),bilateralSCFEisseenmorecommonlyinobesechildren.• distalpartoftheextremity
Spine
• low-backpain.• Lumbardiscdegenera6on.• higherriskofcomplica6onsincludinghardwarefailureandinfec6on,• newerpercutaneous,lessinvasivetreatmentsshowpromisetodiminishtheserisks.• idiopathicscoliosis,poorbracefitandwearinobeseindividuals.
Shoulder and Elbow
• Rotatorcufftendoni6sandshoulderimpingement.• Aopera6ve6me,lengthofhospitaliza6on,andfunc6onaloutcomes.
• shoulderarthroplastyrequirespreciseosteotomiesandcarefulso_6ssuehandling.• Inhumeralheadreplacement,revisionsurgery• reversetotalshoulderarthroplastyhasbeenshowntohavesuccessfulclinicaloutcomes
Foot and Ankle
• Achillestendoni6s,• plantarfascii6s,• andposterior6bialtendondysfunc6on.
Hand
• Carpaltunnelsyndrome• Mul6pletriggerfingers• decreaseinhandgripstrength.
Sports and Arthroscopy
• Meniscaltearsandrotatorcufftendoni6s• ACLRECONpost-trauma6costeoarthri6s.• lossofsuperficiallandmarks
Trauma
• é distalfemur,ankle,calcaneusandinternaldeglovinginjuries.• spontaneouskneedisloca6ons• Obeseelderly,extra-capsularproximalfemur• missedproximalfemurfracture• obesityisarela6veindica6onforretrogradenailfixationorantegradenailfixa6on• Mul6plescrewfixa6on.
Advanced imaging • MostMRIandCTscannershaveweightlimitsthatconven6onallydonotexceed450lbs(202.5kg)• Zoo.
Conclusion:
• Obesityisnotachoice,butratheracomplex,mul8factorialprocessthataffectsalargenumberofpa8entsandinmostcasescontributesnega8velytotheirmusculoskeletalproblems.• Itisequallyimportanttoassurethesafetyofhealthcarefacili8esaddressingthosesitua8onsspecifictotheobesepa8ent.
Thankyou