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PTH et obésité ! Philippe Chiron Toulouse

Explore the relationship between obesity and joint surgeries, including increased risks and potential solutions. Learn about the impact of obesity on knee and hip osteoarthritis, metabolic diseases, cardiovascular conditions, and more. Discover the importance of weight management in surgical outcomes.

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PTH et obésité ! Philippe Chiron Toulouse

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  1. PTH et obésité!Philippe Chiron Toulouse

  2. Definitions BMI= PDS en kg /Taille xTaille en m An adultwho has a BMIbetween25 and 29.9 isconsideredoverweight. An adultwho has a BMI of 30 or higherisconsideredobese. 500 millions of obeses X2 between1980 and 2008 2, 8 millions death/year

  3. In France Obépi 2012

  4. Obesity and Knee OA • Known association between knee OA and obesity • Canadian Joint Registry • BMI > 30 kg/m2  09 X risk • BMI > 35 kg/m2  19X risk • BMI > 40 kg/m2  33X risk * Sabharwal et al. JBSJ Am. 2012 * Felspm et al. Ann Rheum Dis. 1996 * Leach et al. CORR. 1973 * Bourne et al. CORR. 2007

  5. Obesity and Hip OA • Canadian and Norway Joint Replacement Registry • BMI > 30 kg/m2  3X risk • BMI > 35 kg/m2  5X risk • BMI > 40 kg/m2  9X risk Bourne et al. CORR. 2007

  6. Other metabolic diseases: • Dyslipidaemia: • Risk > x 3 • Hyperuricaemia and gout • Risk x 2-3 Type 2 Diabetes: Risk x 12.4in female Risk x 6.7 in male Obesity BMI >30 = Comorbidities • Cardiovascular diseases: • Hypertension • Risk > x 3 • Coronary heart disease • Risk x 3.1 in female • Risk x 1.7 in male • Congestive heart failure • Risk x 1.8 • Pulmonary embolism: Risk x 3.5 • Musculo-skeletal: • Chronic back pain: • Risk x 2.8 • Osteoarthritis: • Risk x 2 in female • Risk x 4.2 in male • Cancer: • Breast cancer in postmenopausal women • Endometrial cancer • Colon cancer Gastro-enterology: Gall-bladder diseases Risk x 2.3in female Risk x 1.4 in male • Pulmonary: • Sleep apnea: • Risk > x 3 • Asthma • Risk x 2-3 • Breathlessness • Risk > x 3 Increased anesthetic risk: Risk x 2 Guh DP,BMC Public Health, 2009 Astrup A, 2001, Public Health Nutrition

  7. Concerns with Obesity & THA • Venous Thromboembolic Events X 4 • Superficial Wound Infections X 5 • Deep Periprosthetic Joint Infections • Hip Dislocations * Namba et al. JOA. 2005 * Friedman et al. CORR. 2013 * Dowsey et al. CORR. 2009 * Haverkamp et al. ActaOrthop. 2011 * Huddleston et al. CORR. 2012 * Malinzak et al. JOA. 2009 * Davis et al. JBJS Br. 2011 * Dowsey et al. JBJS Br. 2010 * Schwarzkopf et al. JOA. 2012

  8. Antibioprophylaxie: ISO, dose ABP x 2 • pour BMI ≥ 35 SFAR, RPC 2005

  9. Deep Periprosthetic Joint Infections (PJI) • Dowsey et al, CORR, 2009 • Morbid Obesity (> 40 kg/m2)  Increase PJI by 9X! • Malinzak et al, JOA, 2012 • Super Obese (> 50 kg/m2)  Increase PJI by 21X!

  10. Can a fat be a thin? • InacioMC, Bone Joint J, 2014 Thosewholostweightbefore and keptit off post-operativelyhad a 3.77 greaterlikelihood of deepSSIs(

  11. Dislocation Overweight RR = 2.5 (95%CI: 1.1–5.5) Obesity RR = 3.7 (95% CI: 1.5–9.3)

  12. Around normal range motion

  13. Risk related to the thigh circumference

  14. The surgicalprocedure

  15. Standard Xraysl • Irradiation Compton effect

  16. Standard Xrays • Enlargement and deformation

  17. EOS Low irradiation No enlargement 1 single test

  18. Résultats – Discussion - Conclusion Comparaison de l’irradiation entre EOS et Rx conventionnelle en fonction de l’IMC Chiron P, Demoulin L, Wytrykowski K, Cavaignac E, Reina N, MurgierJ. Radiation dose and magnification in pelvic X-ray: EOSimaging system versus plain radiographs. OrthopTraumatolSurgRes. 2017.

  19. Résultats – Discussion - Conclusion • Agrandissement de tête mesuré avec EOS • Agrandissementmoyen= 1 • Seuls 4 calculs (2,2%) sur les 186 diffèrent de 1 • Pas de modèles statistiques valides, résultats parlent d’eux mêmes • Pas de corrélation avec l’IMC

  20. Le geste chirurgical / The surgicalprocedure • The operating table, installation, equipment. 170 kilos with accessories, patient at the center 420 kilos with accessories, patient lateralised

  21. Introduction Anesthésie Antibioprophylaxie Thromboprophylaxie Conclusion BM Bradley, J Arthroplasty 2014

  22. The surgicalprocedure • The operating table, installation, equipment.

  23.  There isoften a hiddenathlete in the obese patient!

  24. Current indications Posteriorapproach • THA short stem or standard stem

  25. The surgicalprocedure • The operating table, installation, equipment.

  26. The surgicalprocedure • The operating table, installation, equipment.

  27. BMI < 30Metalback 0,4 mm fill • Titaniummelted laser • fine microstructure • HXLPE set at the factory

  28. Prevent dislocation Prevent wear 0.4mm

  29. Maisongrosse P, Lepage B, Cavaignac E, Pailhe R, Reina N, Chiron P, et al. Obesity is no longer a risk factor for dislocation after total hip arthroplasty with a double-mobility cup. IntOrthop. 2015;39(7):1251-8. Recul moyen: 58.3 ± 27 mois (27 – 159)

  30. Take home message • Le danger commence BMI >30 • Faire maigriruniquementsi BMI>40 (Chir. Baria) • PTH faibleespoir de maigrirensuite • Visited’anesthesie +++++ • EOS • Installation+++ • Voieposterieure • DM ou tête de 36 mm

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