International Conference On Orthopedics And Sports Medicine

 

                International  Conference On Orthopedics  And Sports  Medicine   

Results showed intra-articular injection of microfragmented adipose tissue or platelet-rich plasma had comparable low numbers of failures and adverse events without signs of disease progression in patients with knee osteoarthritis.

“[Microfragmented adipose tissue] MF-AT seems to represent a suitable strategy for knee OA, especially for more advanced cases,” the authors wrote.

                                           

Researchers randomly assigned 118 patients with symptomatic knee OA to receive either a single intra-articular injection of MF-AT or platelet-rich plasma. Researchers collected IKDC subjective scores, KOOS subscales, EuroQol-VAS, EuroQol-5D and VAS for pain prior to the injection and at 1, 3, 6, 12 and 24 months after the injection.

Researchers considered the IKDC subjective score and the KOOS pain subscore at 6 months as the primary outcome. Researchers also evaluated patients’ knees with radiography and high-resolution MRI using the Whole-Organ Magnetic Resonance Imaging Score at baseline and at 6, 12 and 24 months.

Potential risks and challenges for patients with 40-plus BMI

           BMI is independently associated with increased risk of postoperative complications after THA and TKA, says Dr. Bedard. He also indicates obesity usually does not occur in a vacuum, without other health consequences. In fact, it can be a marker of poor overall wellness: Individuals who have a 40-plus BMI tend to be overall less healthy, and often have other medical problems that can increase their risk of complications.

                    Soft tissue depth, which makes implant positioning more difficult for the surgeon

                    Increased risk of wound complications

                    Elevated infection risk

                    Increased risk of dislocation due to soft tissue impingement or tissue levering the joint out of place

 

Mayo Clinic's approach to helping individuals with high BMI who need TKA or THA

                What Dr. Bedard recommends, in light of risks for the patient with high BMI who needs pain alleviation and functional improvement, is optimizing the patient's weight and health pre-surgery. This typically includes the following process with a surgeon, patient and other physicians who specialize in weight loss:

                        

                      Discussing the patient's arthroplasty risks and any patient concerns

                      Setting reasonably attainable health improvement goals

                      Presenting options for how to reach the goals and pros and cons of each potential tool.

Referral considerations for physicians treating patients with high BMI who require arthroplasty

                      Dr. Bedard indicates multiple options exist for physicians to help patients with a high BMI become ready for a TKA or THA. Community physicians should apply similar pre-surgical optimization strategies as those employed by Mayo Clinic. If a physician does not have access to resources to help optimize patients, one option to consider is referring the patient to Mayo Clinic.

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