Obesity negatively impacts musculoskeletal care and outcomes. The document discusses how obesity increases risks for various orthopedic procedures and conditions, including higher rates of infection, non-union, implant failure, and complications. Care for obese patients requires specialized precautions and techniques during procedures due to pressures on tissues and limits of equipment. While challenging, addressing the needs of the growing obese patient population is important for optimizing outcomes.

1. Obesity and Musculoskeletal
Care
Ahmed Alqatub
4th year ICMS

2. Background
• nega6vely affects orthopaedic.
• 1.5 B overweight & 500 M were
obese.
• Overweight 25 - 29.9
• Obese 30 or higher
• expanding perspec6ves on treatment
op6ons and challenge surgical skills.

3. • burden of obesity is significant on a variety of outcome measures
including:
• infec6on risk,
• non-union,
• persistent pain,
• cost, and implant failure.

4. Co-Morbid Condi8ons and Peri-Opera8ve
Management
• diabetes,
• coronary artery disease,
• deep vein thrombosis,
• pulmonary embolus,
• malignancy,
• obstruc6ve sleep apnea, and asthma.

5. Individualized anesthe8c Plan
• peri-opera6ve period, premature death
• Anesthe6c intuba6on with a fiber-op6c.
• Regional anesthesia.

6. • well- padded tables and
boards:
• Pressure ulcera6ons,
nerve palsies, and
compartment syndromes
more readily occur in
obese than non-obese
individuals
• Nursing care.

7. Total Joint Arthroplasty
• Obesity has a direct result on the development of
osteoarthri6s of the hip and knee joints.
• The need for having a TKR
• 8.5 %mes BMI > 30,
• 18.7 %mes BMI > 35,
• 32.7 6mes BMI > 40.
• BMI > 40 appear to have even higher complica6on.

8. TKR
• has higher risks of infec6on,
• increased blood loss;
• wound related problems,
• avulsion of the medial collateral ligament,
• component malposi6oning,
• extensor mechanism rupture,
• and patellar maltracking.

9. • These complica6on rates also increase as the BMI
increases.
• In medial unicompartmental arthroplasty:
• component loosening,
• failure,
• and fracture.

10. THR
• There appears to be evidence that obesity has a direct associa6on
with:
• infec6on rates.
• higher risks for hardware malposi6oning,
• thromboembolic events,
• higher blood loss,
• loosening, infec6on, and ul6mately, catastrophic failure.

11. Pediatrics
• Blount's disease
• increased risk for genu valgum and recurvatum.
• Slipped capital femoral epiphysis (SCFE) , bilateral
SCFE is seen more commonly in obese children.
• distal part of the extremity

12. Spine
• low-back pain.
• Lumbar disc degenera6on.
• higher risk of complica6ons including hardware failure and infec6on,
• newer percutaneous, less invasive treatments show promise to
diminish these risks.
• idiopathic scoliosis, poor brace fit and wear in obese individuals.

13. Shoulder and Elbow
• Rotator cuff tendoni6s and shoulder impingement.
• A opera6ve 6me, length of hospitaliza6on, and func6onal
outcomes.
• shoulder arthroplasty requires precise osteotomies and
careful so_ 6ssue handling.
• In humeral head replacement, revision surgery
• reverse total shoulder arthroplasty has been shown to have
successful clinical outcomes

14. Foot and Ankle
• Achilles tendoni6s,
• plantar fascii6s,
• and posterior 6bial tendon dysfunc6on.

15. Hand
• Carpal tunnel syndrome
• Mul6ple trigger fingers
• decrease in hand grip strength.

16. Sports and Arthroscopy
• Meniscal tears and rotator cuff tendoni6s
• ACL RECON post-trauma6c osteoarthri6s.
• loss of superficial landmarks

17. Trauma
• é distal femur, ankle, calcaneus and internal degloving injuries.
• spontaneous knee disloca6ons
• Obese elderly, extra-capsular proximal femur
• missed proximal femur fracture
• obesity is a rela6ve indica6on for retrograde nail fixation or
antegrade nail fixa6on
• Mul6ple screw fixa6on.

18. Advanced imaging
• Most MRI and CT scanners have weight limits that conven6onally do
not exceed 450 lbs (202.5kg)
• Zoo.

19. Conclusion:
• Obesity is not a choice, but rather a complex, mul8factorial process
that affects a large number of pa8ents and in most cases
contributes nega8vely to their musculoskeletal problems.
• It is equally important to assure the safety of healthcare facili8es
addressing those situa8ons specific to the obese pa8ent.

20. Thank you