Obesity, medically known as obesity (overweight), is on the rise worldwide. According to current studies, over 25% of the population in Germany is obese. At the same time, the demand for hip and knee joint replacements is increasing due to the aging society. However, joint replacement poses a particular challenge, especially in obese patients. The combination of obesity and arthroplasty is complex as it influences both the risk of perioperative complications and long-term outcomes.

This article highlights the risks, the optimal preparation of obese patients for joint replacement and the importance of a healthy metabolism for the success of the operation.

Epidemiology: Obesity (obesity, overweight) and joint replacement in numbers

• Increasing numbers: As obesity prevalence increases, the number of patients requiring joint replacement also increases. Around 50% of endoprosthetic patients have an increased body mass index (BMI) of over 30 and are therefore overweight.
• Higher risk of osteoarthritis: Obesity (overweight, obesity) increases the risk of osteoarthritis many times over, especially in the area of ​​weight-bearing joints such as hips and knees.

Why obese patients are at higher risk in endoprosthetics

Increased risk of infection

Patients with obesity (obesity, overweight) have a significantly higher risk of post-operative infections. Reasons for this are:

• Difficult wound healing: The reduced blood flow to the fatty tissue delays healing.
• Higher skin surface exposure: The risk of skin lesions and infections in the surgical area increases.
• Elevated blood sugar levels: Many obese patients suffer from diabetes or insulin-resistant metabolism, which further increases susceptibility to infection.

Technical challenges during the operation

• Limited visibility: The thick layers of soft tissue make surgical access and optimal placement of the endoprosthesis difficult.
• Longer operation times: Studies show that operations on obese patients often take longer, increasing the risk of perioperative complications.

Mechanical load on the prosthesis

Obesity leads to excessive mechanical stress on the prosthesis, which:

• Relaxations
• Early implant wear
• and can result in increased revision rate

Preparing obese patients for joint replacement

Optimal preparation is crucial to minimize the risks and maximize the chances of success of the operation.

1. Weight loss before surgery

Significant weight loss before surgery can:

• Reduce the mechanical load on the prosthesis,
• Reduce the risk of infection,
• Improve general fitness and thus enable faster rehabilitation.

2. Benefits of weight loss

• Mechanical advantages: Reduced pressure on the joints also relieves the strain on the prosthesis.
• Improved wound healing: A lower BMI leads to better blood circulation and optimizes the body's ability to heal.
• Reduction of systemic inflammation: Weight loss can reduce inflammatory processes in the body that could negatively affect the success of the operation.

3. Preparation through physiotherapy

• Strengthening the surrounding muscles
• Optimization of mobility before the procedure

4. Metabolic management

A recently published study shows that the risk of complications also increases in obese patients in a catabolic metabolic state during surgery. This highlights the importance of a stable nutritional and metabolic status before the procedure. It could therefore also be disadvantageous to reduce weight too intensively before an endoprosthetic procedure.

Surgical peculiarities in obese patients

Implanting a joint replacement for obesity (obesity, overweight) requires specialized surgical techniques to avoid complications.

Minimally invasive techniques

These can be advantageous in obese patients as they make the access more gentle and minimize the risk of wound infections.

Special implants

For overweight patients, robust implants must be used in particular, as well as ideal sliding pairs that can withstand increased mechanical stress.

Aftercare and rehabilitation

Individual rehabilitation plans

Obese patients need customized plans that:

• Promote gentle mobility,
• Address the stress of the new prosthesis,
• Support muscle building step by step.

Nutrition and lifestyle

Sustainable weight loss remains crucial even after surgery.

Future prospects in endoprosthetics for obesity (obesity, overweight)

New technologies

• Robotics and navigation systems: Open up more precise implantation options.

Conclusion

Joint replacement in obese patients undoubtedly involves specific risks, but it can be successfully managed through comprehensive preparation, specialized surgical techniques and sustained aftercare. The benefits of weight loss before and after the procedure are undeniable. However, a catabolic metabolic situation surrounding the procedure should be avoided. The combination of modern medicine and patient-centered care offers obese patients the opportunity to sustainably improve their quality of life.