Hombro/Shoulder/Shulter/Épaule: Peor si tiene sobrepeso

Obesity is associated with increased postoperative complications after operative management of proximal humerus fractures
Brian C. Werner, Justin W. Griffin, Scott Yang, Stephen F. Brockmeier, F. Winston Gwathmey
Journal of Shoulder and Elbow Surgery
Published Online: October 30, 2014

Background
Obesity has become a significant public health concern in the United States. The goal of this study was to assess the effect of obesity on postoperative complications after operative management of proximal humerus fractures by use of a national database.

Methods
Patients who underwent operative management of a proximal humerus fracture were identified in a national database by Current Procedural Terminology codes for procedures in patients with International Classification of Diseases, Ninth Revision (ICD-9) codes for proximal humerus fracture, including (1) open reduction and internal fixation, (2) intramedullary nailing, (3) hemiarthroplasty, and (4) total shoulder arthroplasty. These groups were then divided into obese and nonobese cohorts by use of ICD-9 codes for obesity, morbid obesity, or body mass index >30. Each cohort was then assessed for local and systemic complications within 90 days and mortality within 2 years postoperatively. Odds ratios and 95% confidence intervals were calculated.

Results
From 2005 to 2011, 20,319 patients who underwent operative management of proximal humerus fractures were identified, including 14,833 (73.0%) open reduction and internal fixation, 1368 (9.2%) intramedullary nail, 3391 (16.7%) hemiarthroplasty, and 727 (3.6%) shoulder arthroplasty. Overall, 3794 patients (18.7%) were coded as obese, morbidly obese, or body mass index >30. In each operative group, obesity was associated with a substantial increase in local and systemic complications.

Conclusions
Obesity and its resultant medical comorbidities are associated with increased rates of postoperative complications after operative management of proximal humerus fractures. Obese patients for whom operative management of proximal humerus fractures is planned should be counseled preoperatively about their increased risk for postoperative complications.

Level of evidence:
Level III, Retrospective Cohort Design from Large Database, Treatment Study

Hombro/Shoulder/Schülter/Épaule: parálisis en la silla de playa

Lateral femoral cutaneous nerve palsy following shoulder surgery in the beach chair position: a report of 4 cases.
Satin AM, DePalma AA, Cuellar J, Gruson KI1.
Am J Orthop (Belle Mead NJ). 2014 Sep;43(9)

Abstract

Neuropathy of the lateral femoral cutaneous nerve can present as pain, decreased sensation, and/or burning or tingling on the anterolateral thigh. We present 4 cases of lateral femoral cutaneous nerve palsy following shoulder surgery in the beach chair position, all of which occurred in obese patients. This complication, to our knowledge, has never been reported in conjunction with the beach chair position. We believe that the neurapraxia was due to external compression by the patients' abdominal pannus. Full resolution of symptoms can be expected within 6 months following conservative management. A preoperative discussion regarding this complication should occur with obese patients undergoing shoulder surgery in the beach chair position.

Cadera / Hip / Hüfte: Más inflamación y dolor en pacientes obesos tras PTC

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Roja Motaghedi, James J. Bae, Stavros G. Memtsoudis, David H. Kim, Jonathan C. Beathe, Leonardo Paroli, Jacques T. YaDeau, Michael A. Gordon, Daniel B. Maalouf, Yi Lin

Clinical Orthopaedics and Related Research®

May 2014, Volume 472, Issue 5, pp 1442-1448

Abstract

Background

The prevalence of obesity is increasing, and obesity often leads to degenerative joint disease requiring total hip arthroplasty (THA). Obesity is a proinflammatory state associated with an increase in chronic, low-grade inflammatory response. As such, it may augment the postoperative inflammatory response, which has been associated with postoperative pain and complications.

Questions/purposes

We determined whether severity of obesity was associated with (1) severity of inflammatory response, as measured by the in vivo circulating levels of cytokines and ex vivo functional reactivity of mononuclear blood cells, and (2) severity of pain, as measured by verbal pain scores and analgesic consumption, in the first 24 hours after THA.

Methods

We studied 60 patients (20 normal weight, 20 overweight, 20 obese) undergoing elective primary unilateral THA in this prospective cross-sectional study. Blood samples were collected for C-reactive protein and cytokine levels, including IL-1β, IL-2, IL-6, IL-8, and tumor necrosis factor α (TNF-α), from patients before and 24 hours after surgery. Cytokine response of whole blood was evaluated ex vivo with or without two standard activators, phorbol-12-myristate-13-acetate and lipopolysaccharide, using standardized blood sample from patients at 24 hours. These standard immune activators are implicated in the inflammatory response to gram-negative infection, translocation of microbial products, pathophysiology of septic shock syndrome in human, and tumor promotion. Pain response was gauged using verbal pain scores (on a 0- to 10-point scale, where 0 = no pain and 10 = worst pain) at rest and with activity at 24 hours after surgery and analgesic consumption of volume of epidural analgesic solution for the first 24 hours after surgery.

Results

No correlation was found between BMI and postoperative spontaneous circulating cytokine levels. However, after activation of blood leukocytes with lipopolysaccharide, there was a significant positive correlation between the BMI and IL-1β, IL-6, and TNF-α levels (r = 0.26–0.32; p = 0.03, p = 0.03, and p = 0.01, respectively), suggesting priming of the innate immune system in obesity and potential for excessive postoperative inflammatory response. Obesity was not associated with increased pain or analgesic consumption in the first 24 hours after surgery

Conclusions

Obesity is associated with a proinflammatory state after THA as demonstrated by enhanced cytokine reactivity. Larger studies exploring the specific impact of obesity and inflammation on surgical outcomes, including pain, are warranted.

Level of Evidence

Level II, therapeutic study

Rodilla y cadera /Joint: perder peso antes de la artroplastia

The Impact of Pre-Operative Weight Loss on Incidence of Surgical Site Infection and Readmission Rates After Total Joint Arthroplasty

Maria C.S. Inacio, PhD, Donna Kritz-Silverstein, PhD, Rema Raman, PhD, Caroline A. Macera, PhD, Jeanne F. Nichols, PhD, Richard A. Shaffer, PhD, Donald C. Fithian, MD

J Arthroplasty Volume 29, Issue 3 , Pages 458-464.e1, March 2014

Published online 09 September 2013.

Abstract 

This study characterized a cohort of obese total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients (1/1/2008–12/31/2010) and evaluated whether a clinically significant amount of pre-operative weight loss (5% decrease in body weight) is associated with a decreased risk of surgical site infections (SSI) and readmissions post-surgery. 10,718 TKAs and 4066 THAs were identified. During the one year pre-TKA 7.6% of patients gained weight, 12.4% lost weight, and 79.9% remained the same. In the one year pre-THA, 6.3% of patients gained weight, 18.0% lost weight, and 75.7% remained the same. In TKAs and THAs, after adjusting for covariates, the risk of SSI and readmission was not significantly different in the patients who gained or lost weight pre-operatively compared to those who remained the same.