Morbid obesity and lower limb arthroplasty - A national survey on consultant practice

Rising obesity rates and increasing demand for total hip and knee arthroplasty (THA/TKA) pose growing challenges for orthopaedic services. Despite higher perioperative risk, there is no national guidance in Ireland on managing patients with morbid obesity (BMI >40) who require joint replacement. This study aimed to describe current practices in Ireland regarding the assessment of this patient group.

A 17-question online survey was distributed to 60 consultant orthopaedic surgeons through the Irish Orthopaedic Training Association; 50 responded (83.3%).

The survey received 50 responses with experience ranges from 1 to 30 years (mean 12.9 years) at consultant level. While 66% of consultants would offer THA or TKA to patients with BMI >40, 34% would not. BMI cut-offs were frequently applied (70% for THA, 72% for TKA), most commonly at 40-45, whereas 28-30% reported no threshold. 26% sought a second opinion and 20% engaged in MDT discussion. Pre-operative optimisation was inconsistently available with 68% providing lifestyle advice themselves, none prescribed weight-loss medication, and 56% referred directly to bariatric services. Surgeons estimated a median deep infection risk of 5-6% for patients with BMI ≥40. Awareness of guidelines or local weight-management protocols was low (32% and 24% respectively).

This national survey demonstrates substantial variation in how Irish orthopaedic consultants assess and optimise morbidly obese patients for hip and knee arthroplasty. Reliance on BMI cut-offs, inconsistent access to multidisciplinary input, and limited awareness of obesity-management guidelines contribute to fragmented care. A clearer national guidance policy and coordinated perioperative support may be beneficial to ensure equitable, evidence-based care for this high-risk population.