A survey of Scottish Committee for Orthopaedics and Trauma members on lower limb joint replacement practices in morbidly obese patients

Abstract

Background

Scotland has one of the highest rates of obesity in the developed world which increases risk of lower limb osteoarthritis resulting in total joint arthroplasty (TJA). This paper aimed to investigate (1) current practice of orthopaedic consultants in Scotland in managing end-stage hip and knee osteoarthritis in obese patients, (2) adherence to National guidelines, and (3) understanding of complication risks in lower limb TJA for BMI≥40.

Methods

A 15-question online survey was sent to all active members of Scottish Committee for Orthopaedics and Trauma (SCOT) between February and March 2023 to understand the current practices for managing obese patients with lower limb arthritis requiring joint replacement surgery.

Results

The survey received 62 responses from members of SCOT. The experience ranges from 1 to 44 years (mean 15 years) at consultant level. 61 % of respondents were aware of the SCOT National Guidelines for lower limb TJA in obese patients. 72 % would offer TJA to patients with a BMI>40.35 % would get a second opinion and 22 % discuss these cases in a multidisciplinary team meeting. 71 % were aware of the local weight management guidelines. 77 % quoted risk of deep infection to be between 1 and 30 %, and 40 % quoted risk of amputation between .002 % and 10 % in morbidly obese patients.

Conclusion

Surgical management of obese patients with lower limb osteoarthritis in Scotland is variable. A standardised approach would be beneficial in obtaining informed consent.