Obesity and joint replacement surgery are two topics that are oftentimes connected to one another. Being overweight or obese increases your likelihood of osteoarthritic degeneration in your joints, which may lead to the need for a replacement procedure, but being obese also increases your risk of problems associated with joint replacement surgery. The association of obesity and surgical complications during joint replacement is so significant that many surgeons will not perform a replacement operation on a patient over a certain Body Mass Index. While there is no specific cutoff, a recent survey of orthopedic surgeons found:
- Less than half would operate on a patient with a BMI over 40.
- Only 11 percent would operate on a patient with a BMI over 50.
- Only 3 percent would operate on a patient with a BMI over 55.
When you consider that more than 22 million Americans currently have a BMI over 40 and 3.9 million have a BMI over 50, you begin to realize just how difficult it can be for a heavier patient to find a surgeon who will help with their joint replacement procedure.
Why Aren’t Doctors Operating?
So why aren’t doctors helping this portion of Americans by moving forward with a joint replacement procedure? The main reason is because the prospect of surgery and recovery becomes a lot more difficult as BMI rises. The heavier the patient, the more likely it is that they’ll develop certain complications, like blood clots or the onset of an infection. Not only are these risks more likely, but the effects of these complications also tend to be more severe in patients with high BMIs.
A 2017 study took a closer look at the risks that patients with very high BMIs faced when considering hip replacement surgery. For the study, they compared the surgical success rates of patients with a BMI over 50, also known as super obese. They found that patients with super obesity had much higher rates of postoperative complications after total hip replacement surgery than those classified as nonobese (BMI <30), obese (BMI between 30 and 39.9) and morbidly obese (BMI between 40 and 49.9). This led researchers to conclude that super obesity was an independent risk factor for increased rates of postoperative complications, including the need for earlier revisional operations after an initial replacement procedure.
So what are obese patients to do? Some unsympathetic doctors will simply tell them to come back to their office when they’ve lost 30 pounds, but we know that this isn’t realisitic for many people. If you’re obese and in pain because of severe arthritic degeneration, the process of exercising, even at low levels of intensity, seems impossible. However, that doesn’t mean that a doctor should just move forward with a replacement procedure with every patient who comes into their office. At the end of the day, doctors take an oath to protect their patients from harm, and for some patients, the risk of surgery is too great compared to the potential upside, and moving forward with this procedure could do more harm than good.
At the end of the day, it really comes down to having an open and honest conversation with your orthopedic surgeon during your first consultation. If you’re obese, your weight will be a topic of conversation, but that’s only because we want everyone to be on the same page when it comes to how this potential risk is managed. We’ll talk with you about exercise habits, dietary choices and what we need from you in order to move forward with an operation. You’re not just a number on a chart to Dr. Botero, you’re a real patient with specific challenges that need to be managed on an individual level. We’ll do everything we can to set you up for success with your operation and recovery, but you have to show a willingness to do your part to help reduce the risk of post-op complications.
To have that first conversation with an orthopedic specialist about joint replacement, your weight and how we can get you back to living a fulfilling life, reach out to Dr. Botero and his team today at (865) 558-4444.
