Perioperative management of the obese orthopaedic patient.

With nearly a third of American adults considered be obese, it is increasingly important that orthopaedic surgeons be familiar with management issues pertinent to these patients. Preoperative examination must assess cardiopulmonary status and other comorbid conditions, most notably diabetes. Intraoperative considerations include requirements for special equipment, patient positioning, intravenous line placement, central monitoring lines, and anesthesia specific to the physiologic changes in obese patients. Postoperatively, obese patients have higher rates of deep vein thrombosis and wound sepsis than do nonobese patients, and they may differ from other patients in supplemental oxygen requirements, medication dosing, and outcomes in intensive care units. Obese patients can successfully undergo virtually all orthopaedic procedures; however, the procedures are frequently more technically challenging, and obese patients appear to have higher rates of prosthetic failure, infection, hardware failure, and fracture malunion, although many of these complications can be minimized by appropriate countermeasures.