Total knee arthroplasty in the obese patient: tips and quips.

As defined by body mass index, 1 of every 3 Americans is overweight. The excuses and reasons for this situation are genetic, dietary, cultural, and physiologic. Scandinavian literature has shown a higher incidence of gonarthrosis in obese patients and some indication of decremental surgical results. Patient selection requires identification of the distribution of the obesity and its implications for knee surgery. Anesthetic techniques should stress regional approaches, oxygenation, and modified postoperative regimens. Surgical incisions should be midline, should be longer than normal, and should involve eversion of the patella within its fat envelope. Increased tourniquet length and width are mandatory. Although wound complications are more common, the overall statistics from total knee arthroplasty in obese patients are not discouraging. Greater pressure is placed on the surgeon to achieve perfect alignment and balance because the patient's weight could unmask the imperfections of the arthroplasty. Only 18% of obese people lose weight after joint replacement. Copyright 2002, Elsevier Science (USA).