Practice Patterns in Body Mass Index Optimization Among US Arthroplasty Surgeons: Results of a National American Association of Hip and Knee Surgeons Survey.

Abstract

As total hip arthroplasty and total knee arthroplasty procedures are increasingly performed on younger patients with obesity, the optimal approach to preoperative weight management remains undefined. This study explores national trends among US arthroplasty surgeons regarding body mass index (BMI) cutoffs, weight optimization strategies, and weight loss medication usage. A 28-question national survey was distributed through e-mail to members of the American Association of Hip and Knee Surgeons and shared on professional social media platforms (Facebook, ResearchGate, and LinkedIn) between January 1 and August 5, 2024. Regarding arthroplasty reconstruction fellowship training, 82.58% (441/534) of respondents were fellowship trained, 11.42% (61/534) were not fellowship trained, and 5.99% (32/534) trained in other specialties. In terms of BMI optimization strategies, 82.84% (n = 444/536) recommended structured diet and exercise programs, 77.99% (n = 418/536) recommended dietitian or weight loss specialist programs, and 52.61% (n = 282/536) advocated for bariatric surgery. For total hip arthroplasty, 45.13% of surgeons used a BMI cutoff <40 kg/m2 (n = 241/534), followed by 23.97% advocating for no strict cutoff (n = 128/534). For total knee arthroplasty, 41.65% reported using a cutoff of <40 kg/m2 (n = 222/533), with 24.39% (n = 130/533) reporting no strict BMI cutoff. In addition, 27.62% (n = 58/210) reported that their patients used weight loss medications such as GLP-1 agonists. Notably, 68.0% (n = 356/526) of surgeons allowed up to 1 to 2 years for BMI optimization before surgery. Although many arthroplasty surgeons use BMI cutoffs, many accommodate patients through nonsurgical interventions to facilitate weight loss. These findings indicate that many respondents report a multidisciplinary approach to preoperative BMI optimization.