The incidence of hip and knee replacements is increasing and will continue to do so for the next two decades. With the transformation of healthcare reimbursement to a value-based, episode-of-care model, there will be closer scrutiny of all factors that affect outcomes of joint replacement surgery. Such factors include those on the orthopedic surgeon‘s side, such as their experience and ability, as well as patient factors such as weight, overall health, presence of medical co-morbidities, and implant factors.
Large database studies have documented the increased incidence of complications among individuals who are obese based on their BMI. As hospitals, outpatient facilities, and surgeons will be evaluated and reimbursed based on occurrence of complications, patient related factors will be scrutinized more closely in the future. Obesity rates continue to rise in the United States, impacting over a third of our population, many of whom suffer from joint issues. The rate of obesity approaches 50% in joint replacement patients. The reasons are multifactorial, but the primary reason is diet i.e. what we consume on a daily basis.
In his book How Not to Die, co-authored with Gene Stone, Dr. Michael Greger outlines his thoughts about diet, health, and avoiding common causes of an unhealthy diet. He discusses how patients often say, “I don’t eat that much but just seem to gain weight.” However, it’s not just about how much we eat, but what we eat. Increasingly, patients will be asked to optimize their health prior to consideration of joint replacement surgery. As part of this optimization, weight loss, diabetes control, smoking cessation and better strength will be stressed. Gone will be the days of the “Doc, you just have to fix me” mentality. These changes, while requiring adjustments, will be beneficial in the long run for individual patients and the healthcare system overall. By adopting best practices for pre-op patient optimization, surgery, patient care, aftercare and rehab, we can optimize outcomes while hopefully reducing costs.