Can You Have Orthopedic Surgery With Obesity?
One of the most concerning and debilitating consequences of excess weight and obesity revolves around how it affects our joints. We all have experienced adding several pounds over the summer or on vacation, making us feel sluggish and creating real physical Impediments. What you feel during these times is matched and even magnified in your joints. For example, it’s estimated that your knees experience an additional 4 pounds of pressure for every pound of excess body weight. You can imagine that even a little extra weight makes a big difference.
With that said, a chemical reaction is also occurring in your body due to visceral or white fat – the bad stuff that accumulates around your abdomen, increasing the risk of metabolic disorders and heart disease. This fat releases pro-inflammatory compounds that attack the joints and break them down even further.
The result? Often debilitating pain as cartilage is worn away. Eventually, this allows bone to rub on bone and causes severe disability.
Joint Replacement in Patients With Obesity
Advances in technique and technology have made joint replacements more successful than ever. Hip replacements are so successful these days that most patients get back on their feet immediately after surgery, and a full recovery and return to regular activity is swift. However, will orthopedic surgeons perform a joint replacement procedure on an obese patient?
The Answer Is That It Depends
Because of the abovementioned issues, obese patients are generally at significantly higher risk for complications during and after their surgical procedure. During surgery, anesthesia is probably the biggest concern, with obese patients at higher risk for cardiovascular events. After surgery, metabolic disease can cause additional complications, not to mention excess weight, which can increase the likelihood of a poor outcome with the artificial joint. Ultimately, every patient is different, but we must look at the averages when creating guidelines for surgical intervention. Patients with a BMI up to 40 may be candidates for a joint replacement or other orthopedic intervention. Generally, patients over a BMI of 40 may have more significant complications, and most orthopedic surgeons are unlikely to perform an elective procedure at those levels. Patients showing substantial and sustained weight loss but still slightly over the 40 BMI threshold may be accepted as surgical candidates by their orthopedic surgeons.
Excess weight and obesity create a downward spiral when it comes to our musculoskeletal system. They can cause significant bone and joint problems while precluding orthopedic intervention for those very issues. Many patients remain in pain until they lose significant weight. For some closer to the 40 BMI threshold, new weight loss medications like Wegovy may help get them to the point where they can have their orthopedic procedure. Weight loss medication may not be enough for those with a BMI significantly higher than 40. Instead, a preliminary bariatric procedure may be required for weight loss and subsequent qualification for orthopedic surgery.
Interestingly, some people find that as they lose weight, either from medication or bariatric surgery, their joint problems improve or disappear altogether. This does not mean the cartilage has regrown or is no longer diseased, but the need for surgery may be delayed.
For any questions about excess weight and orthopedic interventions, we encourage you to contact our office, especially if your orthopedic surgeon has told you that bariatric surgery may be necessary before you have a joint replaced.