“As I embark on this four-year term, my priority is to champion and listen to our members, ensuring they have the resources, education and support necessary to navigate the evolving healthcare landscape,” said Dr. Parks. “Alongside my fellow AAOS Board members, I am committed to improving musculoskeletal health through collaboration, innovation and patient focus. I am honored to serve in this role and to advance AAOS’ mission of serving our profession to provide the highest quality musculoskeletal care.”

Dr. Parks has made a significant and lasting impact as a physician, advocate and mentor. Among his many AAOS volunteer positions, Dr. Parks served as treasurer, BOD member-at-large, chair of the AAOS Resolutions Committee, chair of the AAOS Finance Committee and chair of the Workgroup on Obesity. He was also a member of the Board of Councilors, AAOS Annual Meeting Committee and Communications Cabinet and selected to the 2003 class of the AAOS Leadership Fellows Program. His leadership was recognized with the AAOS’ Diversity Award in 2019 and Achievement Award in 2012.

Read the full article at aaos-annualmeeting-presskit.org/. 

A specialist in the surgical treatment of arthritis in adults, Dr. Parks is highly regarded for his expertise in reconstructive procedures for the hip and knee. His clinical research focuses on joint replacement surgery and emphasizes reducing health disparities and addressing socio-economic factors affecting healthcare outcomes. His insights have been featured in leading publications, including New York magazine, The New York Times Magazine, Black Enterprise magazine and Money magazine.  Dr. Parks also has appeared on the NBC-TV TODAY show where he discussed treatment alternatives for knee arthritis in baby boomers.

In addition to his leadership within the AAOS, Dr. Parks is a past president of the Orthopaedic Research and Education Foundation and the New York State Society of Orthopaedic Surgeons. He served as a member of the BOD of the American Association of Hip and Knee Surgeons and has been actively involved in the Movement is Life Caucus, a multi-stakeholder group devoted to decreasing musculoskeletal health disparities.

Dr. Parks graduated from Duke University with a Bachelor of Arts in chemistry and went on to earn his medical degree from the Medical University of South Carolina in Charleston, where he received the President’s Clinical Science Award. After completing an internship in general and thoracic surgery, followed by an orthopaedic residency at Duke University Medical Center, he continued his training at Hospital for Special Surgery in New York with a fellowship on the Hip and Knee Service where he remains in practice today.

“Patient satisfaction related to the hospital experience following surgery is an important aspect of patient care,” said Susan M. Goodman, MD, a rheumatologist at Hospital for Special Surgery (HSS) and senior investigator. “The Press Ganey inpatient survey is commonly administered to patients to assess their satisfaction with the process of care. Our aim was to determine whether overall patient assessment scores differed by race or socioeconomic status.”

Dr. Goodman and a team of researchers reviewed the Press Ganey survey responses of more than 4,600 patients who had surgery at HSS from July 2010 to February 2012. Individuals having a primary knee or hip replacement who resided in New York, New Jersey or Connecticut were included in the study.

Researchers analyzed the data to establish an overall score, calculated as the mean of a patient’s ratings for three questions in the “Overall Assessment” section of the Press Ganey survey. The results were categorized as either “completely satisfied” (score of 100) or “not completely satisfied” (score <100).

The analysis, which included 2,516 individuals who underwent hip replacement and 2,113 who had a knee replacement, found that Black patients were more likely to indicate they were “not completely satisfied” compared to white patients in both joint replacement groups.

Dr. Goodman said that although Black patients indicated they were less satisfied with the process of care right after surgery, there was no difference in satisfaction with their joint replacement outcome. Factors such as pain and function are part of the outcome assessment, which is generally conducted two years after surgery.  

With respect to socioeconomic status, researchers considered the patient’s primary health insurance coverage. The study found that the individual’s primary payor was not associated with satisfaction in either joint replacement group.

“The study is important because we know that Black patients generally wait longer to seek treatment, presenting with worse pain and function prior to surgery, and we are trying to sort out the barriers to seeking timely care,” said Mark P. Figgie, MD, chief emeritus of the Surgical Arthritis Service at HSS and co-author of the study.

“Patient outcome measures indicate that although Black patients achieve significant improvement after surgery, it does not reach the same level as those who seek timely treatment,” he added. “Confidence in the health care system may contribute to the delay in seeking care, and this is something we need to address.”

Dr. Goodman added, “More research is needed to investigate other factors, such as perceived staff courtesy and baseline pain and function, to understand why disparities exist so we can achieve a high level of patient satisfaction for everyone.”

Authors: Anne R. Bass, MD, Emily Ying LAI, MSc, Huong Do, MA (HSS), John A. Gibbons, BA, Letitia Bradford, MD, FAAOS, FACS (Nth Dimensions), Mark P. Figgie, MD, Michael L. Parks, MD (HSS), Orett Burke, BS (Rutgers Robert Wood Johnson Medical School), Susan M. Goodman, MD (HSS).

Now, researchers at Hospital for Special Surgery (HSS) have examined racial disparities separately for aseptic and septic revision total knee replacement using data from three large states. In their study published July 21 in JAMA Network Open, they found that Black patients had a 39% higher risk of aseptic revision and an 11% higher risk of septic revision than white patients.

“As we predicted, the risk factors were very different for patients needing aseptic versus septic revision,” says lead and corresponding study author Anne R. Bass, MD, rheumatologist at HSS. “But we were totally surprised to find Black race was one of the only risk factors associated with aseptic revision and that this disparity was so much higher for patients treated at high-volume hospitals.”

Dr. Bass and HSS colleagues analyzed data from statewide databases from California, Florida and New York for almost 725,000 patients who had total knee replacement between 2004 and 2014. The investigators looked at an extensive range of variables that have been linked to risk of revision total knee replacement in previous studies, including age; sex; insurance status; presence of other conditions such as diabetes, obesity, renal disease and chronic obstructive pulmonary disease (COPD); inflammatory arthritis; surgical site complications; infection on admission for knee replacement surgery; and hospital factors, including non-government, not-for-profit, teaching hospital, rural location, number of beds, and annual total knee replacement volume.

In addition to being Black, other factors associated with a higher risk of septic revision total knee replacement were diabetes, obesity, renal disease, COPD, inflammatory arthritis, surgical site complications, Medicaid insurance and low hospital total knee replacement volume. Similarly, for aseptic revision, additional risk factors were male sex, workers’ compensation insurance and low hospital total knee replacement volume.

When the researchers analyzed the data according to different categories of hospital volume, they discovered Black patients had a 20% higher risk of aseptic revision total knee replacement than white patients if they underwent replacement at low-volume hospitals, defined as 89 or fewer total knee replacements annually. However, the relative risk was 68% higher for those who had knee replacements at very high-volume hospitals, defined as 645 or more procedures per year.

“The question now is why do these disparities exist,” says Dr. Bass. “Our study did not reveal causes, but we can use this learning to develop theories for further investigation.”

“We know that Black patients tend to bypass larger, higher-volume hospitals and have surgery at lower-volume hospitals,” says study co-author Michael L. Parks, MD, a hip and knee surgeon at HSS. “One of the reasons why they may have higher revision rates at higher-volume hospitals is that they tend to present later with more advanced disease and require more complicated surgeries than white patients.”

“The other hypothesis is that care is not being delivered equally across patient groups at high-volume hospitals,” says Dr. Bass. “If that’s the case, hospitals should review and ensure care processes are accessed and applied equally across racial groups to improve surgical outcomes.”

Dr. Bass, Dr. Parks and colleagues are currently conducting further research to look for a relationship between revision total knee replacement risk, hospital volume and annual volume by surgeon to see if they can learn more about racial disparities.

The study was supported by funding provided by the Stavros Niarchos Complex Joint and Reconstruction Center at HSS.

“In our retrospective analysis, we found the utilization rate of bilateral knee replacement was much lower in African American patients compared to white patients,” said Bella Mehta, MBBS, MS, a rheumatologist at HSS. “On the other hand, although African Americans having unilateral knee replacement have been shown to have higher in-hospital complication rates compared to white patients, this pattern was not consistent for bilateral knee replacement during the time period we studied.” She presented the findings on November 9 at the virtual American College of Rheumatology annual meeting.

Dr. Mehta and colleagues compiled information from the National Inpatient Sample (NIS)- Healthcare Cost and Utilization Project (HCUP) database from 2007 to 2016. They looked at trends in utilization and major in-hospital complication rates of unilateral versus bilateral knee replacement nationwide in patients age 50 and older.

Investigators assessed racial differences over time, adjusting for age, sex and comorbidities; hospital variables, including hospital volume, number of beds, region and teaching status; and community level factors, such as median household income.

From 2007 to 2016, 5.5 million unilateral and 276,000 bilateral knee replacements were performed in the United States. The percentage of bilateral knee replacements declined from 5.53% in 2007-08 to 4.03% in 2015-16.

The researchers found that African Americans were much less likely to undergo a double knee replacement compared to white patients during the years analyzed. In-hospital complication rates varied throughout the study period, with no significant difference between African American and white patients.

To explain the study findings concerning complication rates, Dr. Mehta said there could be a more rigorous patient selection process when considering candidates for same-day bilateral knee replacement. Regarding the lower number of African Americans having the bilateral procedure, she said physicians may be offering it less often to African American patients or they may be choosing not to have the procedure.

“Since the complication rate for bilateral knee replacement is not higher for African American patients, health providers should work to provide access to all appropriate patients,” Dr. Mehta said. She noted that future studies could take a closer look at the patient selection process or assess the role of an individual’s health insurance plan in utilization of the bilateral procedure.

“As we seek to achieve health equity for our patients, we must understand the challenges they face in accessing care, as well as variance in their outcomes,” said Michael L. Parks, MD, hip and knee surgeon at HSS and study author. “Our ultimate goal is to provide the same quality of care to everyone.”

Bella Mehta, MBBS, MS, a rheumatologist at Hospital for Special Surgery (HSS) in New York City, presented the findings at the American College of Rheumatology/Association of Rheumatology Professionals annual meeting on November 11 in Atlanta.

“With the aging of the population, elective total hip replacement has become one of the fastest-growing procedures to manage severe osteoarthritis,” said Dr. Mehta. “By 2030, the number of hip replacements is expected to reach 572,000 annually in the US. Medicare, the largest payer of joint replacement surgery, has introduced several payment reform models that target discharge destination and risk of hospital readmission after surgery. Our study examined how the socioeconomic status of the community in which one resides influences discharge destination and the odds of 90-day hospital readmission after hip replacement.”

Dr. Mehta noted that where a patient receives post-op care and rehab has a considerable impact on the total cost of hip replacement surgery. Previous studies have demonstrated significant variations in outcomes and costs due to individual factors such as race. There have been far fewer studies on the impact of community-level factors.

“Our study pushes the envelope by examining the role of where one lives in understanding variations in post-op care after elective joint replacement surgery. And it reflects the growing academic collaboration in clinical research between HSS and Weill Cornell Medicine investigators,” explained Said Ibrahim MD, MPH, MBA, senior investigator and chief of the Division of Healthcare Delivery Science and Innovation at Weill Cornell Medicine.

For the analysis, the investigators identified almost 85,000 patients in the Pennsylvania Health Care Cost Containment Council database who had elective hip replacement surgery between 2012 and 2016. The researchers used the Area Deprivation Index (ADI) from the American Census Survey, which reflects a geographic area’s level of socioeconomic deprivation and is associated with health outcomes.

In addition to discharge destination, the investigators assessed the risk of 90-day readmission for patients sent to a facility compared to those who received their post-op care and rehab at home. The researchers also assessed the interaction of race and ADI on outcomes.

The study found that patients from impoverished communities were more likely to be discharged to an institution compared to home after a hip replacement. The interaction effect of race and ADI on discharge destination was statistically significant in African American patients 65 years and older, but not in patients under 65 years old. The level of community deprivation did not have an effect on 90-day hospital readmission, nor did the interaction of ADI and race.

As a possible explanation for the study findings, Dr. Mehta noted that patients from impoverished communities may have less access to community-based services such as social support. Thus, discharge to a facility for post-operative and rehabilitative care might be perceived as a safer option in clinical decision-making.

“Our study is important because it advances our understanding of the relationship between health care and social determinants of health,” said Dr. Ibrahim. “Future studies should determine which specific community factors influence discharge destination and how they could be modified to allow more patients to go home after a hip replacement.”

Dr. Mehta added, “The ultimate goal of research is to design socially informed health policies to improve quality of care and outcomes.”

Susan M. Goodman, MD, and Michael L. Parks, MD, of HSS and Kaylee Ho, MS, of Weill Cornell Medicine were also involved in the study.

The regional database analysis study was published in JAMA Network Open, an open access journal of the American Medical Association, on October 30. It was a collaborative effort among researchers from Hospital for Special Surgery (HSS) in New York City (Michael L. Parks, MD), the University of Alabama at Birmingham (Jasvinder Singh, MBBS, MPH), the University of Pennsylvania (Yong Chen, PhD) and Weill Cornell Medicine/New York Presbyterian Hospital (Said A. Ibrahim, MD, MPH). The study included patients who had elective knee replacement surgery in the state of Pennsylvania between 2012 and 2015.

“Total knee replacement is one of the most common and successful elective procedures performed in adults with arthritis, and previous studies have described racial disparities in outcomes,” said Dr. Parks, hip and knee surgeon at HSS who was involved in study concept and design and in drafting the manuscript. “For this study, we wanted to determine if there was an association of race/ethnicity with discharge destination and hospital readmission after this procedure.”

Demand for total knee replacement in the United States has been projected to increase by more than 600% between 2005 and 2030. In a 2009 national estimate, the number of total knee replacements performed in the United States exceeded 750,000 surgeries annually.

The study authors noted that postoperative care and rehabilitation after surgery account for a significant portion of the overall cost of care. In 2014, the Centers for Medicare & Medicaid Services, the largest payer of total joint replacement, introduced the Medicare Bundled Payment for Care Improvement initiative, which included payment models to hold hospitals accountable for costs related to joint replacement for 90 days after patients' hospital discharge.

In addition to analyzing the racial/ethnic variation in discharge destination, the researchers also wanted to determine if postoperative discharge to an inpatient rehab facility or skilled nursing facility was associated with higher odds of hospital readmission up to 90 days after surgery. They noted that hospital readmissions are not only costly and associated with an increased morbidity burden; they also represent a major policy initiative for Medicare reimbursement.

For their retrospective study, investigators used data from the Pennsylvania Health Care Cost Containment Council. It included demographic information from all discharges of patients who underwent elective primary total knee replacement in 170 hospitals in Pennsylvania from April 2012 to September 2015. They compiled statistics on how many patients went to an inpatient rehab center, how many went to a skilled nursing facility for rehabilitation and how many received their rehab at home after a knee replacement.

“The analytic sample, which included a total of 107,768 patients, found that African American patients were 2.5- to 5-times more likely than white patients to be discharged to an inpatient rehabilitation facility or skilled nursing facility rather than to their home. In 2015, almost 50 percent of African American patients were discharged to a skilled nursing facility,” said Dr. Parks.

Among patients younger than 65, African American patients also had 1.3-times higher odds of 90-day hospital readmission, although there was no difference in hospital readmission rates in patients who were 65 or older. Discharge destination to an inpatient or skilled nursing facility for rehabilitation was associated with increased odds of hospital readmission.

Noting that their findings are significant, the researchers wrote: “It is possible that the decision on where to discharge patients after a surgical procedure is informed not only by clinical indications but also by social determinants of health, including socioeconomic status, employment, and social support, of which race/ethnicity might be a marker.”

They noted that future studies are needed to evaluate the decision­making process regarding discharge destination and how social determinants of health affect these decisions. They advised that future studies should also examine how Centers for Medicare & Medicaid Services policy reforms, such as Bundled Payment for Care Improvement, affect not only cost and quality of care, but also equity.

“We need to understand that there are people who may not fit into the new complex reimbursement bundles who require specialized care, and we need to make sure we address their needs going forward,” Dr. Parks said.

OTW spoke to Dr. Parks about the significance of being a recipient of this award, who noted, "I am honored to be recognized by the AAOS. In order to provide care for an ever-increasing diverse population, we must understand their needs. The diversity of our faces helps with this understanding and ultimately our ability to provide excellent care for the patients we serve." Dr. Parks shared, "My dad’s inaction in the face of progressive knee osteoarthritis lead to my initial interest in disparities research. I watched his pain increase and mobility decrease yet he refused to consider surgical treatment. After many years, he did eventually relent and lived the remainder of his life pain free with unlimited mobility. In my own care of patients, I also observed many black and Hispanic patients with severe osteoarthritis who also refused to consider joint replacement."

Dr. Parks also disclosed, "In our first study we tried to understand how minority patients went about the process to consider joint replacement. Since then we have sought to further understand other factors including poverty, education and language proficiency and their direct effect on disparities in utilization and outcomes."

Read the full article at ryortho.com.

The Diversity Award recognizes members of the Academy who have distinguished themselves through their outstanding commitment to making orthopedics more representative of, and accessible to, diverse patient populations, according to the organization. Dr. Parks received the award at the Academy’s 2019 Annual Meeting in Las Vegas.

"I am honored to be recognized by the AAOS," Dr. Parks said. "In order to provide care for an ever increasing diverse population, we must understand their needs. The diversity of our faces helps with this understanding and ultimately our ability to provide excellent care for the patients we serve."
 
Dr. Parks specializes in total joint replacement at HSS, where he is vice chair for Quality and serves on the hospital’s Board of Trustees. He has led a number of research projects at HSS, with a particular interest in socioeconomic and racial disparities in access to arthritis care and total joint replacement surgery. He has published numerous articles in professional journals related to these topics. 
 
"HSS strives to deliver optimal care and services to all of our patients by adopting initiatives, behaviors, attitudes, and policies that enhance cultural competency and inclusion while serving diverse populations," said Louis A. Shapiro, president and CEO of HSS. "We applaud Dr. Parks for his efforts and his work in this area, and are extremely proud that a member of the HSS staff has received the AAOS Diversity Award."
 
Colleagues describe Dr. Parks as an exemplary leader who is actively involved in many organizations working to eliminate racial, ethnic and gender disparities for both patients and future physicians.  
 
In 2018, Dr. Parks was named president of the Orthopaedic Research and Education Foundation. He is a former president of the New York State Society of Orthopaedic Surgeons and has served on the Board of Directors of the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons.
 
Dr. Parks is a member of the steering committee of the Movement is Life Caucus, which seeks to understand and address disparities in musculoskeletal health care. He is also actively involved with Nth Dimensions, a nonprofit organization that works to increase representation of women and minorities in orthopedic surgery. 
 
Dr. Parks was born and raised in Columbia, South Carolina. He graduated from Duke University with a Bachelor of Arts in Chemistry and went on to earn his medical degree from the Medical University of South Carolina in Charleston, where he received the President’s Clinical Science Award. After completing an internship in general and thoracic surgery, followed by an orthopedic residency at Duke University Medical Center, he continued his training at Hospital for Special Surgery with a fellowship on the Hip and Knee Service. 
 

Michael L. Parks, MD, hip and knee surgeon at HSS, explains that rheumatologists and orthopedic surgeons may collaborate under varied circumstances, but the most common scenario is for a patient under rheumatologic care on maximal medical therapy who is still not fully controlled.

Also part of the Integrative Rheumatology and Orthopedics Center at HSS, Dr. Parks says that "historically, patients with rheumatoid arthritis were challenging medically and needed to be followed more closely".

"Now, with the excellent treatment available with many medications, patients are not as likely as they were in the past to present with destructive arthritis requiring surgery," he adds.

Read the full article at The-Rheumatologist.org.

Dr. Parks told OTW, "the OREF Board of Trustees and staff have prioritized rekindling relationships and exploring collaborative opportunities with many of our orthopaedic partners, and reinforcing transparent and regular communication and dialogue exchange."

"We will continue working with our partners as well as mobilize OREF's ambassadors and volunteers to communicate our research goals and promote evidence-based data on the breadth, scope and impact of OREF-funded research," he added.

Read the full article at ryortho.com [subscription required].

The mission of OREF is to improve lives by supporting excellence in orthopaedic research. Since its founding in 1955, OREF has awarded over 4,700 grants, providing more than $146 million in support of orthopaedic research. It is led by a Board of Trustees made up of orthopaedic surgeons across the country and key members of the business community.

Dr. Parks began his two-year term as president effective March 5. He has been a trustee member since 2013 and a donor since 1998. Dr. Parks has also served as co-chair of the OREF James R. Urbaniak, MD Mentor Campaign, which raised money to fund research in regenerative medicine and cellular therapies.

He succeeds former president, David G. Lewallen, MD, orthopedic surgeon at Mayo Clinic.

"OREF is the leading grant resource for new investigators by providing important financial support necessary to provide a foundation for their careers," said Dr. Parks. "I am honored to lead this organization as it continues to support research to improve function, eliminate pain and restore mobility, thereby making life better for all patients."

Dr. Parks, who joined HSS as a fellow in 1996 before becoming an attending in 2008, is a hip and knee surgeon at HSS. Specializing in hip and knee replacement, Dr. Parks focuses on the surgical treatment of adults with arthritis. His research interests include biomechanical implant retrievals and the impact of race, ethnicity and gender on the care of arthritis patients.

Recently, Dr. Parks led a clinical trial testing how the use of a shared decision-making tool affects the way that minority patients decide on knee pain treatment. While socioeconomic and racial disparities in healthcare are well known, how to address these issues is not well defined.

He is a former president of the New York State Society of Orthopaedic Surgeons and has served on the Board of Directors of the American Academy of Orthopaedic Surgery (AAOS) and the American Association of Hip and Knee Surgeons (AAHKS). He is also on the steering committee of the Movement is Life caucus, which is a multi-stakeholder group devoted to decreasing musculoskeletal health disparities.

As president, Dr. Parks will be the principal executive officer of the Foundation and will supervise and control all of the business and affairs of the Foundation. He will preside over all meetings of the Board of Trustees and perform all duties incident to the office of Board President.

L to R: Michael L. Parks, MD, OREF President; David G. Lewallen, MD, OREF Past President; John J. Callaghan, MD, a past president and trustee

Outside of the OR, Dr. Parks enjoys traveling to the far corners of the world.

According to the article, Dr. Parks will serve a two-year term.

"I firmly believe that it's more critical than ever that all of orthopaedics comes together to identify research priorities to improve patient care and establish shared goals that move each of our subspecialties forward with energy and purpose," said Dr. Parks in a past issue of AAOS Now Daily.

This originally appeared on MySanAntonio.com.

As a world leader in both orthopedics and rheumatology, HSS has the unique opportunity for physicians across both specialties to collaborate in research and integrate findings into patient care. While collaboration has always occurred during the history of HSS, the IROC is the first formalized center created for this sole purpose.

"As director, I hope to establish better data collection tools and resources to continue our research in perioperative medicine," said Susan M. Goodman, MD, rheumatologist and director of the IROC. "One of the issues we are investigating is how patients with a rheumatic disease respond to a hip or knee replacement compared to those who do not have a rheumatic condition."

Dr. Goodman and her team are currently collecting joint tissue from patients with rheumatoid arthritis undergoing joint replacement surgery. During the typical hip or knee replacement, joint tissue is excised, and the IROC team has incorporated the access to tissues into their study design. By examining the tissue, the researchers are able to simultaneously study the clinical manifestation of the disease along with the biologic information including genetic information.

"As physicians, it is clear our problems are easier to solve when we work together," said HSS hip and knee surgeon Michael L. Parks, MD. "We study multi-dimensional issues that require varying perspectives from a diverse group of experts. Working together with Dr. Goodman and the rest of the IROC team will continue to ensure the best surgical outcomes for our patients."

Dr. Goodman and her collaborators have shown that patients from impoverished neighborhoods have poorer hip and knee replacement outcomes than patients from wealthier neighborhoods. However, education seems to be protective, so that those patients with higher education do just as well as those from wealthy neighborhoods. As part of the ongoing collaboration at the IROC, Dr. Goodman hopes to identify additional medical and social factors that contribute to poor healthcare outcomes as well as factors such as education that seem to improve outcomes.

"We want to optimize outcomes for everyone," said Dr. Goodman. "Regardless of financial situations, people should have the opportunity to live a pain-free life and enjoy everyday activities that many of us might take for granted."

According to the article, researchers studied more than 2,000 adults who had joint surgery and found that obese patients had a 35 percent higher risk of dependence after surgery.

HSS hip & knee surgeon Michael L. Parks, MD, who did not participate in the study, said it is important to note that improvement was seen for most obese and non-obese participants.

"So, the point is, joint surgery is still helpful whether patients are obese or not, but it shows that we need to do something for them more than just replace their joint," said Dr. Parks.

"One of the things that we do here at HSS, and that I hope is becoming more prevalent nationally, is we work collaboratively with our medical colleagues to try to address obesity," he added.

Furthermore, Dr. Parks advised that patients should "become involved in health and do something to lose weight to make yourself a better candidate because that has implications on your surgical outcome, your risk, and this study shows that it has a long-term outcome on your dependence and your ability to be independent and your mobility".

Read the full article at reuters.com. A subscription is required to access.