obesity and musculoskeletal care general concepts

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