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Spring AAHKS 2018: Tackling Obesity in Orthopaedics

The American Association of Hip and Knee Surgeons -- AAHKS for short -- attracts total joint arthroplasty surgeons and hospital administrators from around the country to learn about and discuss the latest advancements in orthpaedics. Our team just returned from a productive Spring AAHKS meeting, where hot topics included strategies for same-day joint replacement and bundled payment, and how to tackle opioid and pain management. However, one of our favorite talks was about managing high BMI patients seeking joint replacement.

This is an incredibly important and complex topic, as nearly 40 percent of adult Americans are obese -- 7.7 percent of which are considered severely obese. Individuals with high BMI are naturally at greater risk for requiring joint replacement, but frequently denied the elective procedure based on procedural and complication risk. But it’s these patients who often need it most.

To improve health and lose weight, gradually increasing physical activity is critical. Yet for patients who are overweight and in pain, many are simply unable to reach suggested activity levels. This leaves patients discouraged, left with limited options, and often hope for a positive outcome.

So what can we do?

We asked Dr. Stefano Bini, Orthopaedic surgeon and digital health thought leader, what his main takeaway was from Spring AAHKS 2018. Here’s what Dr. Bini had to say:

“I think there were several takeaways but one of the most important was the new information we heard about the management of obesity, the success of the new surgical procedures performed by our bariatric surgery colleagues, and the potential to work together to improve patient success with joint replacement in the context of obesity.”

He and colleagues from the University of California San Francisco, as well as many other groups, are brainstorming collaborative approaches to tackle such issues in Orthopaedics that link back to obesity.

The methodologies discussed by Dr. Bini and other panelists suggest a teamwork approach, marrying the expertise of bariatric and orthopaedic teams, to treat the root cause of a patient’s health prior to performing joint replacement surgery. The multimodal approach aims to prepare patients who would have previously been unqualified for joint replacement, lose weight so they can undergo surgery and get back to walking with comfort, and living the lives they often never thought possible.

Value-based care and bundled payment initiatives are nudging providers to change their behavior, innovate and redesign for more affordable and accessible care. And the collaborative efforts aforementioned encourage behavior change for the most important stakeholder: the patient.

As newer surgical methods continue to advance, they no doubt yield better outcomes and speedier recovery times. But it’s the collaborative methods like this, personalizing care and putting the patient at the center, that will truly push healthcare forward.

Many providers getting an early start on bundles and outpatient joint replacement are gaining material competitive advantages, from increased volume and market share, to more scalable models for the future. They heavily leverage patient selection tools and processes to identify prime surgical candidates. Commonly, healthier patients mean lower costs, so to optimize outcomes and financial performance in the bundle, providers prioritize these candidates.

Though as we continue to see more and more providers enter bundled contracts, aiming to attract optimized patients, a growing population of patients will get left out.

The wide array of value-based care movements within orthopaedics are helping to advance towards care that is more affordable, accessible and higher quality -- but healthcare is about the patient, and we can’t leave our most vulnerable patients out. Innovative and collaborative approaches that focus the patient at the center, treating the whole patient will move us to a healthier and more sustainable healthcare system.


Dr. Stefano Bini is widely recognized as an innovator and thought-leader of all things digitally transformative in the Orthopaedic space. Dr. Bini is a Professor of Orthopaedic Surgery specializing in hip and knee replacement at the University of California San Francisco. He is also the Founder and Chair of the Digital Orthopaedics Conference (DOCSF) and The Regenerative Orthopaedic Conference (ROCSF).

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