Total hip arthroplasty in obesity: separating 'fat' from fiction.

Obesity is a modern-day epidemic with increasing prevalence that is directly impacting the global burden of primary total hip arthroplasty. The risk of requiring total hip arthroplasty for osteoarthritis increases incrementally with increasing obesity class. Surgical intervention in obese patients presents a set of unique challenges that should be recognized by the treating medical team. Although predominantly satisfactory outcomes have been reported, perioperative anaesthetic and surgical concerns require thorough patient assessment. There is an increased potential risk of thrombogenic and septic complications, but the body mass index cutoff level beyond which total hip arthroplasty should not be offered in the obese patient remains controversial. Preoperative medical optimization of the patient and appropriate intraoperative interventions are essential to mitigate the risk of complications.

Development of a lower limb arthroplasty service in a developing country : Lessons learned after the first 100 cases (joints).

There is emerging evidence that total hip arthroplasty (THR) can be safely practiced in developing countries but scant evidence of safety of total knee replacement (TKR). The purpose of this study is to evaluate the outcomes of these procedures focusing on procedure related complications. This is a retrospective study of the first 100 arthroplasties (92 patients) consisting of 58 TKR and 42 THR with a minimum follow-up of 26 months (range of 26 to 47 months). Major complications included deep infection in one TKR and dislocation of one THR and one TKR. Two patients died in the second post-operative week from cardiac events following TKR. Blood transfusion rate for hips and knees was 13.7% and 5.6% respectively. THR can be safely performed in less than ideal circumstances in developing countries in carefully selected patients. More importantly this study demonstrates that TKR can be safely practiced under the same circum-stances.