title: Modifiable Risk Factors in Total Joint Arthroplasty: A Pilot Study.
abstract: Strong evidence exists to suggest that morbid obesity, smoking, and poorly controlled diabetes mellitus are associated with poorer outcomes after total joint arthroplasty. To our knowledge, no study has reported the effect of the implementation of a risk reduction strategy. Risk factors, based on published data, were defined as Body Mass Index (BMI)>40, Hemoglobin A1c (HbA1c) >8.0, and use of any tobacco product. A retrospective pilot review was done of a 3-month period using this protocol in the practice of a single fellowship-trained academic arthroplasty surgeon (DRJ). Outcomes were evaluated in the subsequent 3-month period. Overall 19/29 (65.5%) patients identified to be "at risk" and offered support for modification followed up under the care of their index surgeon. 11/19 (57.9%) improved their risk factors and 8/19 (42.1%) ultimately met the specific goals set for surgery with 4 (21%) ultimately undergoing their replacement procedure during the 6-month study period. These initial results suggest that a significant proportion of our patients were willing and able to modify their risk before surgery.
  
  
  METHODS
  Level III retrospective study. [Full article available at http://rimed.org/rimedicaljournal-2016-05.asp, free with no login].
authors.affiliation: Resident Physician, Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI. Rhode Island Hospital, Miriam Hospital.
authors.forename: Steven F
authors.initials: SF
authors.lastname: DeFroda
authors.affiliation: Assistant Professor, Department of Orthopedic Surgery, Division of Adult Reconstruction, Alpert Medical School of Brown University, Providence, RI. Attending Surgeon, Rhode Island Hospital, Miriam Hospital. University Orthopedics, Inc., Providence, RI.
authors.forename: Lee E
authors.initials: LE
authors.lastname: Rubin
authors.affiliation: Assistant Professor, Department of Orthopedic Surgery, Division of Adult Reconstruction, Alpert Medical School of Brown University, Providence, RI. Attending Surgeon, Rhode Island Hospital, Miriam Hospital. University Orthopedics, Inc., Providence, RI.
authors.forename: Derek R
authors.initials: DR
authors.lastname: Jenkins
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology*; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D010865:Pilot Projects; D012189:Retrospective Studies; D012307:Risk Factors; D064424:Tobacco Use / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin
keywords: Diabetes Mellitus; Obesity; Risk Factor; Tobacco use; Total Hip Arthroplasty; Total Knee Arthroplasty