Am I too Heavy to Have a Hip or Knee Replacement?

Until recently, if you weighed over 180-200 lbs, you were not considered to be an acceptable candidate for joint replacement surgery. Patients were told “come back when you lose weight and then you can a have a ticket to enter my operating room.” Much has changed over the past 20 years. Now, patients who are overweight or obese can expect clearance for surgery.

With the advent of non-cemented load bearing hip implants and improved joint bearing hip and knee surfaces and designs, heavier patients may now enjoy the pain relief and increased activity levels of joint replacement. However, it is in the best interest of the overweight patient and his surgeon to encourage weight loss prior to surgery. One pound of weight is equivalent to 4 or 5 pounds of pressure on the lower extremity joint. Next time you check in your 40 pound suitcase at the airport, consider how comfortable you would feel if you could lose that 40 pounds of weight you may be carrying!

Not only does weight loss help the surgeon with the surgical exposure during joint replacement, but the other medical concerns associated with obesity – hypertension, diabetes, leg swelling from circulation problems, fatigue, sleep apnea – may significantly decrease. Quite often my overweight patients will say “Doc, do my surgery and then I will exercise and lose this weight!” One of my former mentors often suggested that after surgery the only exercise his overweight patients would do was to walk faster to the fridge with his new hip or knee.

Morbid obese patients even have a higher risk of post-op complications with wound healing and mobility concerns. If you cannot get out of bed and walk regularly after surgery, chances are high that you will have problems with your lungs, circulation (deep vein thrombosis) bladder infection, and constipation. In my practice, if you are morbidly obese (greater than 100 pounds over ideal weight) or have recently gained a large amount of weight, I encourage these folks to make a serious effort to lose weight. Suggesting that they consult with their family doctor often proves futile. Joining Weight Watchers or some ethical supervised program is often the best solution. Family commitment is critical to helping the patient change a lifetime of bad habits. Some patients will need consultation with a program specializing in the surgical therapy of morbid obesity.

I have rarely operated on anyone weighing over 310lbs. Sometimes my most motivated and best patients are heavy active individuals who are super energetic about returning to an active lifestyle. I do not need to spend much time to convince them to lose some weight and get into some exercise routine. The key to success is all about keeping a positive attitude and getting on the right track to achieve your goal. I work with each patient to explore what their goals are in order to help them in their personal journey. “Get up, get out, and get moving” is my motto!

 

28 Comments

  1. Arthur Gelinas

    My mother in law is heavy. 350 ish. Her knees cause her so much pain and she cannot take any pain meds at all due to past ulcers. But she needs help. She gets up with help of my father in law. Walks with a Walker to bathroom and then back to her chair. She cannot walk anywhere she wants. She is 70. Wants so bad to be able to go where she wants. She is not a over water what so ever. Please help if you can…

    • Juanita

      I just had cryoablation ti my right knee. It is not a new procedure but is new to our hospital. They are not sure how long my pain relief will last. It is hopeful it will last 3 months. Then it can be done again. I understand exactly how she feels. I have ZERO PAIN! It is immediate after the procedure. The knee is cleaned and several injections are given to numb the knee. This is the worse part. An ultrasound is used to locate nerves and mark on the skin where the nerves are. Once numb, the Cryoablation tool that resembles a very large pen, is used to freeze the nerves. There are three needles in each one. The knee is numb so no pain is felt with this. Once the nerves are frozen there are no pain signals to the brain. So no pain is felt. I could stand and bend my knee with absolutely no pain. First time in years! Both knees can be done. I highly recommend this procedure. One knee takes about an hour from start to finish. It will change her life! Her Orthopedic physician should be familar with this procedure or recommend a physician that is. No anesthesia. Radiologist actually does the procedure. In and out in an hour! Good luck.

      • Tee

        I had that same procedure by a highly recommended surgeon. I was told that it will take a few days before I feel any relief however, I do not feel any relief. It seems as if my knee has gotten weaker and the pain is still there. I have bone on bone so I don’t know why I thought that this would help with my knee pain. Today will be 2 months now and two days ago I had to go back to getting cortisone injections to relieve some of my pain. Everybody knee pain is different some people get relief from removal of fluid in the knee. My aunt had knee surgery and weighs about 140-150 and still have problems with her knee. I tried everything and I don’t know what else to do.

    • jodi Rousseau

      I’m260 and had to work hard to find a surgeon. But I did, and I am way more active now that I’m pain free. I’m so thankful that I found someone who understood me as an individual and not just the numbers on the scale.

      • chris kruse

        Wana – where are you scheduled for surgery and who is your doctor. I would travel to him if he would accept me.
        I am almost totally immobile due to my knees and one hip.
        Please advise as I am at the end of my rope.

  2. Karen Flower

    You’ve probably saved my life today. I’ve been in pain for 4 years without a diagnosis, however I’ve been prescribed with lots of pills. Recently, last couple of years, stayed in bed & 3 steps away from my en suite, just existed without further support, no idea it was available. Thankful I could get an online grocery delivery. The only person I saw.
    Because I requested a shower chair instead of stool my life altered unexpectedly. I was being assessed for care.. To relate to such positive people changed my dismal outlook on life to feeling there could be a future for me.
    cut it short, if a person was needed to forfeit their life for some b!izarre reason, I’d gladly volunteer.
    Finally diagnosed with needing a double hip replacement after a 2nd. Xray. Life has been rotten as previously told nothing to be done for me. Now told to cut down drinking (agreed) & to lose 3 stone. How? Then I read consultant’s decision not GPS and it is they who would decide if I could be operated on. Hope to no hope to hope! I was seriously going to make that final irreversible step – I felt defeated. Thank you, I will refer to you when I push to see my elected consultant in the NHS

    • Christina Quinones

      Hi Karen, I was just told by an orthopedic surgeon that I needed a double hip replacement but he will only perform it if I lose 15 pounds. I weigh 300 lbs. if my scale is accurate. On opioid pain meds and it still a ten on my right hip pain scale. I live in New York. Any advice? Christina Q.

  3. Sarah

    Do you know someone that is preferably in Illinois that will do a knee replacement operation on a female who weighs 285? I weighed 354 lbs for 30 years and I went on every diet out there and stuck to them; none of them worked. Finally I started working with an individual who gave me a keto type diet and I was able to get down to 285 by some miracle. I’m practically eating nothing. Just wanted to also mention this is not our fault we don’t run to refrigerators like someone posted in a comment about their colleague, we don’t overeat, these diets don’t work for us. If you know of anybody in Illinois that will do this knee replacement operation for me it would be very life-changing. I do not feel I have to apologize for my existence because I’m big, I’ve done all I can do and I feel I should be able to walk like everybody else. If people don’t care it’s really no problem I’ll just stay collecting a check on disability.

    • Linda Pace

      I support your feelings. I’m tall,was slim in my childhood but have gained weight over the years. Both knees are shot and need replaced but l need to lose some serious weight, lm not diabetic even though that’s the first thing people think of when they see me, I seriously do watch what I eat what I drink but when your knees and hips and lower back hurts as bad as mine do it’s hard to get out and walk exercise ride a bike when I’m not even stable on grass or uneven surfaces. My message to you is stay positive keep working on the weight loss do it because you want to do it not because you feel the world is judging you and good luck on whatever you decide ,you and your doctors .

  4. MaryAnne Taylor

    stated in the article:
    “One of my former mentors often suggested that after surgery the only exercise his overweight patients would do was to walk faster to the fridge with his new hip or knee.”
    Well, isn’t THAT the compassionate, caring physician. Glad he’s not my doctor!
    How insulting! How judgy.

    How about people who are obese for other reasons- not merely because they “run to the fridge all day?”
    I’ve been on high doses of thyroid medication for more than 30 years. I eat well, and I do NOT over-eat. I can go weeks without eating a single dessert. I’m 64 now, and I’ve been heavy nearly my entire adult life. I’m at my heaviest these last 5-8 yrs because of the bad osteoarthritis in both knees. It is extensive, tri-compartmental OA. I also have OA in my hands and shoulders.
    Being fat didn’t cause my OA, but it seems that being fat might keep me from getting the medical care and intervention that thinner people can get.
    I hope I can eventually find a surgeon who will believe I’m worthy of medical care and relief from debilitating pain, and not tell me to have bariatric surgery FIRST before they will help me, like the doctor who is treating me now with cortisone shots in my knees every 3-4 months…

  5. My wife is 50 years old and she is overweight she is about 340 lbs .her knees were hurt pretty bad from a car accident and it put her in a wheelchair for a long time.she has arthritis all over in her body but mostly in her knees I help her out of her chair and do a lot of leg work for her. But long story short she can’t walk very far because of the pain but she seen a doctor and he told her she has to lose weight and she can’t exercise or anything because of arthritis in her joints and she has a full time job is there a surgeon willing to do surgery for knee replacement just one knee needs it bad.i hope this note finds someone who will do surgery. Thanks

  6. George Sarach

    I’m 54 years old I use to hunt fish drag race in the past few years I dont do none of it cause bother knees are bad I smoked for 40 years but knee dr said quit smoking and I’ll do it so I quit but gaind weight then he wouldn’t do it now I bearly walk I sit n watch my boat sit my race cars n hunting my kids are missing out cause I cant go I dont want surgury for weight loss I need help I haven’t smoked in 4 years but I weigh over 500 at one time I was 545 I am now 506 it’s a very slow process I need help please I beg of you I will do anything

  7. Shellisha

    I am 46 year old and my right knee completely have no cartilage in it. My orthopedic doctor told me that my BMI has to be at 40 and under to get the knee replacement surgery.

  8. Ris

    Sadly….some ORTHO physicians LACK the bedside manner or care to dive a bit deeper. After losing 150 lbs with weight loss surgery, the surgeon suggested I go lose 40 more and asked if I had considered weight loss surgery. As an expert in his field he lacked bedside manner and lost my trust.

  9. Susan Lewis

    I was told to lose weight for knee replacement surgery no cartilage in my knees said replacement was my only option. Walking hurts so bad I try not to. I now have 3 grand babies I would love to be able to run after. PLEASE HELP!

  10. Sara Stewsrt

    The orthopedic profession should come up with different shaped implants, different cementing procedures, different surgical practices or something so that they can get larger size patients up and walking. I think we’ve seen that the old lose weight thing just doesn’t work. You cannot will your genes and metabolism to use weight. I’ve been dieting and sticking to diets for 40 years or more. now I went on a keto type diet and I lost from 354 down to 280 lbs. Now my surgeon says yet I need to lose another 30 lbs!! This is like almost impossible to do. so I feel I lost all that weight for nothing. So I guess that you guys like to pay our disability insurance. Come up with something besides telling people lose weight, it doesn’t work. It’s not our fault.

    • Tee

      I am 350 and was told to lose weight before surgery but I see that a lot of people say they was told to lose more weight after losing over 200lb. Maybe, surgery is not needed for everybody because everybody knee pain is different. After you lost all that weight did your knees feel better with lesser pain? Im hoping if I lose weight I would not be in so much pain.

  11. Lorraine richards

    I’m 17 stone and got osteoarthritis in both my hips my left hip is ready for op I’m in terrible pain all the time the smallest of things are agonising my consultant says I need to lose two stone he won’t even give me an appointment to see him says it’s pointless I’m depressed crying all the time because of the pain I can’t walk far at all I’m at my wits end please help

  12. Vivian E Phelps

    I am down to 410 from 550. Desperate need hip and and both knee surgery çan I get it now or do I need to loose more weight first?

  13. Perez

    I’m 52 year old weigh 225 can i get s hip replacement. I do have high blood pressure and am a diabetic but my doctor will not do surgery what should i do can’t take the pain anymore

  14. Lynn

    I am 61 years old, I had a total knee replacement done in February of 2017. There was rheumatoid arthritis in my knee. I was in surgery a long time lost a lot of blood and had to get 2 pints. Now my left knee is bone on bone I am so scared of having another knee replacement because my other one still swells, hurts and tingles. However, I have to do something, I can hardly walk.

  15. Teresa A Conley

    I would love to lose weight. I need a double knee replacement. I have had 2 surgeons tell me to lose weight in order to get this done. But, if I can’t move to walk even 1/4 mile then losing weight is difficult. Exercise is key not just a reduction in calorie intake.

  16. Laura

    “One of my former mentors often suggested that after surgery the only exercise his overweight patients would do was to walk faster to the fridge with his new hip or knee.“
    This comment is devastating. This is why overweight people are so reluctant to go to their doctors where they are judged by their weight. Add to the fact that orthopedic surgeons are often ex-college jocks and the only patients they really love helping are jocks or other athletes. What a shame.

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