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. There is a range of accepted weight ranges, but the current standard is that anyone obese (greater than 100 pounds over ideal weight or a BMI of roughly 40-45) should not consider joint replacement.
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 a BMI of roughly 40-45) 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!