# Identifying sarcopenia and sarcopenic obesity in a lower extremity arthroplasty clinical setting: a pragmatic pilot study

## TL;DR

This pilot study explores the feasibility of identifying sarcopenia and sarcopenic obesity in patients undergoing lower extremity joint replacement surgery.

## Contribution

The study demonstrates a pragmatic approach to screen for sarcopenia and sarcopenic obesity in a clinical arthroplasty setting using established diagnostic criteria.

## Key findings

- Only 6.25% of patients were identified with sarcopenia or sarcopenic obesity using the screening methods.
- Low strength testing was completed by 99% of patients for handgrip strength but only 44.5% for chair sit-to-stands.
- DXA testing confirmed sarcopenia in 3 and sarcopenic obesity in 5 of 16 patients assessed.

## Abstract

Sarcopenia and sarcopenic obesity may increase surgical complications and impact recovery and function after total joint arthroplasty (TJA). We assessed the feasibility of identifying these conditions in an orthopedic practice setting using published consensus criteria. Patients in a lower extremity TJA clinic were assessed for sarcopenia and sarcopenic obesity using EWGSOP2 and ESPEN/EASO diagnostic frameworks, respectively. Low strength testing involved maximal handgrip strength (HGS) and number of chair sit-to-stands in 30 seconds (CSTS). Same day dual-energy x-ray absorptiometry (DXA) testing was used to assess for low muscle mass (i.e. appendicular lean soft tissue) in patients with low strength. One hundred-one of a possible 128 patients were assessed in clinic (93% male, mean age 69.6±8.9 years and BMI 31.7±7.9 kg/m2). HGS was completed in 99% of screened patients; only 44.5% completed CSTS due to joint pain and balance limitations. Thirty-nine patients had low strength and were recommended for DXA. In 16 patients who completed DXA, 3 had sarcopenia and 5 had sarcopenic obesity. Screening for sarcopenia and sarcopenic obesity was challenging to complete in all patients during routine clinic flow with dedicated personnel. Despite our pragmatic approach and limited screening completion in all patients, we identified sarcopenic and sarcopenic obesity in 6.25% of patients. This is likely a lower bound for the true prevalence but suggests an opportunity to assess and intervene for these conditions before surgery to improve total joint arthroplasty outcomes.