International Delphi Consensus Guidelines on Total Knee Arthroplasty in Obese Patients
Overview
An international panel of experienced orthopedic surgeons reached consensus on key aspects of managing obese patients undergoing total knee arthroplasty (TKA). The study identified critical BMI thresholds, perioperative optimization strategies, intraoperative techniques, and postoperative management protocols to improve outcomes in this high-risk population.
Background
Obesity is increasingly prevalent among patients requiring total knee arthroplasty, leading to higher complication rates and healthcare costs. Existing guidelines are limited, and there is conflicting evidence regarding revision risks in obese patients. This study aimed to develop a consensus on defining obesity in TKA candidates, optimizing preoperative, intraoperative, and postoperative care to enhance surgical outcomes.
Data Highlights
Parameter
Consensus Achieved
Round
Number of panelists
51
N/A
Geographical distribution
Asia (24), USA (11), Europe & UK (11), Australia (7)
N/A
Total questions
26
N/A
Statements reaching consensus
9
7 in Round 1, 2 in Round 2
Consensus threshold
≥80% agreement
N/A
Key Findings
Consensus was reached on 9 out of 26 clinical questions regarding TKA in obese patients.
Panelists agreed on the importance of defining obesity with specific BMI cut-offs for surgical decision-making.
Preoperative optimization protocols tailored to obese patients were endorsed to reduce perioperative risks.
Intraoperative precautions including surgical techniques and implant selection were highlighted as critical for improving outcomes.
Postoperative management strategies were recommended to address the unique challenges in obese TKA patients.
The Delphi method facilitated iterative feedback and refinement, ensuring robust expert agreement.
Clinical Implications
These consensus guidelines provide a structured framework for orthopedic surgeons managing obese patients undergoing TKA, emphasizing patient selection, surgical planning, and tailored perioperative care. Adoption of these recommendations may reduce complication rates and improve functional outcomes in this growing patient population.
Conclusion
This international Delphi consensus establishes evidence-informed guidelines to optimize total knee arthroplasty care in obese patients. Implementation of these recommendations can enhance surgical safety and efficacy amid the rising prevalence of obesity.
References
International Delphi Consensus Study 2024-2025 -- Guidelines on TKA for Obese Patients
