Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization: Obesity and Malnutrition-Part Four of the Movement Is Life Special ONJ Series.
Martha Kebeh, Chloe C Dlott, Donna Kurek and 2 others
PMID 38546679WHAT IT FOUND
For patients awaiting joint replacement, obesity and malnutrition are linked to worse outcomes, and nurse navigators reported using BMI cutoffs, dietitian referrals and weight programs.
These are recommendations and associations, not tested treatment effects.
Key findings
01Nurse navigator discussions found seventy-six percent of institutions used BMI cutoffs, with thresholds from 35 to 50 kg/m2 and 48% using 40 kg/m2.
02The reviewed literature associated obesity and malnutrition with worse postoperative outcomes, including infection, wound complications, revision, readmission, longer stay and higher costs.
03The authors recommend multimodal, long-term weight management before joint replacement and shared decision-making on weight-loss goals of 5–10% of body weight.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
It is a narrative review and nurse navigator perspective paper, not a trial, so it cannot show that BMI cutoffs, weight programs or nutrition interventions improve patient outcomes. The number of nurse navigators consulted is not reported, so their practices may not represent all institutions. The literature search is not described as a systematic review with quality appraisal, and malnutrition definitions varied across the paper. Some nurse navigators had contact with patients only shortly before surgery, so preoperative optimization may have been too late to change weight or nutrition.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the BMI cutoffs, dietitian referrals, weight-loss programs or nutrition recommendations as proven treatments that improve joint replacement outcomes. This paper reports nurse navigator practices, literature associations and expert recommendations, not tested patient outcomes.