Obesity and Total Joint Replacement:
What is the definition of obesity?
Obesity is defined as BMI (Body Mass Index) greater than 30
BMI is a simple and widely used method for estimating body fat. BMI is calculated by dividing a person’s weight by their height.
Nearly one third of all Americans are obese. This represents a 110% increase in the last 25 years. There is a strong association between obesity and arthritis. It is estimated that obesity is responsible for 200,000 joint replacement a year in the USA.
Does size matter?
Size does matter. In fact, the patient's weight and body habitus has a lot to do with the success of the joint replacement. For instance, it is easier to operate on a tall and light patient than on a short, heavy patient.
The size of the knee or hip determines the length of the incision, the difficulty of the exposure and the amount of time spent in surgery. Increase size and girth of the limb often make surgery more difficult.
Does obesity increase the risk of the operation?
Obesity does increase the risk of the operation. Specifically, obese patients have higher risk of infection, blood clots, wound complication, and blood loss. Moreover, because the surgery is more difficult in the obese patient, the risks of surgical complications are also increased. These surgical complications include malposition and malalignment of the implants, and joint instability, such as dislocation. Because of the size and post-operative swelling, it is also typical for the obese patient to achieve less motion the corresponding normal patient.
How can one decrease the risk of surgery?
Medical and/or cardiac clearance is imperative in preparing for total joint replacement surgery. Often times, a stress test, cardiac catherization and/or pulmonary evaluation will be required to assess the patient’s risk. Weight loss may be necessary to decrease risk of surgery.
Is weight loss important pre-operatively?
In most instances, weight loss does help. Every little bit counts. Most surgeons will prefer that the patient follow a well-balanced diet and exercise program before undergoing joint replacement. A consultation with a registered dietician can help patients achieve significant weight loss and improvement in overall health. In some patients who are morbidly obese, some surgeons will recommend considering bariatric surgery prior to undergoing joint replacement. Because joint replacement is elective, most patients have time to lose weight and improve their health before undergoing surgery. It is important to remember that weight reduction is a good thing done properly. Weight loss should not be accomplished at the cost of good overall nutritional status.
Are bilateral procedures safe in obese patients?
Bilateral knee replacements or hip replacements may be contraindicated for the obese patient. Bilateral procedures take more time to perform and are physiologically more stressful for the patient. In general, obese patients have a harder time getting over bilateral joint replacement and it is more dangerous for them. Cardiac and pulmonary complications can be increased, as well as transfusion requirements. There may be a higher risk of poor outcome following bilateral procedures in obese patients with unacceptable risk of complications.
What should a patient look for when considering joint replacement?
The patient should choose a surgeon with vast experience in total joint replacement. Choose a doctor who understands the special needs of the large patients and has experience treating obese patients. The obese patients have special needs. This includes special surgical techniques, such as computer-assisted surgery, that can aid the precision and accuracy of the procedure. This also includes special equipment, such as special operating room tables, special retractors, beds, wheelchairs, etc. It is important to have trained staff, such as nurses and therapist who understand the needs of the obese patients.
Does the Rothman Institute have surgeons specializing in the obese patient?
The physicians at the Rothman Institute have vast experience in treating obese patients. Our surgeons are trained in the latest techniques in joint replacement. |
