Aligning Priorities of Surgeons and Patients Regarding Obesity and Joint Replacement: Recommendations of the Advisory...

Elective total joint arthroplasty (TJA) in patients with a high body mass index (BMI) or obesity is a complex and nuanced topic. Patients' and surgeons' perspectives on how to address the challenges related to TJA in high BMI patients may differ, highlighting an imperative to include perspectives from both groups in strategizing approaches to improve care. Hip and knee arthroplasty surgeons and patients with high BMI and osteoarthritis were included in a consensus working group (Advisory Committee Co-dEsigning SolutionS regarding Obesity and Arthroplasty [ACCESS-OA]) to identify areas of agreement and disagreement on priorities to improve TJA care for patients with a high BMI. In this white paper, we report on the results of this working group. Based on consensus scoring, the working group prioritized addressing uncertainties in (1) presurgical patient optimization, (2) surgeon education and training, and (3) shared decision-making. Advancing research and practice in these priority areas could have important clinical impact.