New research offers hope to obese patients for hip and knee replacement: What does it mean?

Art Young -   Print  |

Chronic conditions, such as diabetes and heart disease, have long been associated with obesity. However, being overweight or clinically obese can also result in the painful condition of osteoarthritis (OA).

The Arthritis Foundation notes that in some cases “obesity raises the risk of getting some types of arthritis; in all cases, obesity makes arthritis worse. One in five Americans has been diagnosed with arthritis, but according to the Centers for Disease Control and Prevention (CDC), that number jumps to more than one in three among obese people – and two out of three Americans are either overweight or obese.”


It does not require a medical degree to understand the basic physics of obesity’s effect on joints. The more weight that is placed on a joint, the more stressed it becomes, and the more likely it will wear down and become damaged. This is especially true with weight-bearing joints, such as the knees and hips.


Experts note that for every pound of excess weight an additional four pounds of pressure is placed on the knees. Thus, 10 pounds of weight equal 40 pounds of extra pressure. It is not uncommon for a clinically obese person to be 100 pounds overweight, adding a staggering 400 pounds of extra pressure! This is part of the reason that people who are overweight are at a greater risk of joint wear and tear, which can lead to OA.


Arthritis specialists have also noted that the extra weight is not the only factor in joint destruction. The fat itself is active tissue that creates and releases chemicals, many of which promote inflammation.


Because of the constant pain of osteoarthritis, chronically overweight, older people often consider joint replacement for knees and hips. Orthopedic surgeons have in the past have encouraged these patients to lose weight before having the procedure but this may change.


New Research on Obesity and Joint Replacement Surgery


A new study has found that obese patients who underwent knee or hip replacement surgery reported virtually the same pain relief and improved function as average-weight joint replacement patients six months after surgery.


According to the lead researcher and author of the study from the University of Massachusetts, Dr. Wenju Li, “Our data shows it’s not necessary to ask patients to lose weight prior to surgery. It’s challenging for a patient who is severely overweight and suffering in pain to exercise – often they just can’t do it. Our evidence showed that severe morbidly obese patients can benefit almost equally as normal-weight patients in pain relief and gains in physical function.”


The Journal of Bone and Joint Surgery noted that the aim of the study was to evaluate the extent of pain relief and functional improvement in total joint replacement patients with various levels of obesity. The researchers concluded that while obesity is associated with a greater risk of early complications, obesity in itself should not be a deterrent to undergoing total joint replacement to relieve symptoms.


Obesity is Still a Risk Factor for Joint Replacement


Despite this new study, Dr. Donald Hohman, Jr., an orthopedic surgeon who specializes in hip and knee replacement and a member of the referral line at Texas Health Spine & Orthopedic Center, is still concerned about the challenges of joint replacement among morbidly obese patients.


“I believe this research demonstrates what many surgeons would tell patients: that they would expect obese patients to have relief and function well following surgery. However, I would caution the interpretation of this paper to indicate that there are no risks associated with obesity and joint replacement.


“It has been well documented that obesity is a major risk factor for any number of complications following joint replacements and there is also substantial research that documents severe obesity is an independent risk factor for slow recovery over three years for both hip and knee arthroplasties.”


Dr. Hohman cited another, less obvious complication for joint replacement among obese patients: infection.


“Despite advancements and improvements in methods for preventing infection, periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty. Prevention is the most important strategy to deal with this disabling complication, and prevention should begin with identifying patient-related risk factors.


“Medical risk factors such as morbid obesity, malnutrition, hyperglycemia, uncontrolled diabetes mellitus, rheumatoid arthritis (RA), pre-operative anemia, cardiovascular disorders, chronic renal failure, smoking, alcohol abuse and depression, should be evaluated and optimized prior to surgery. Recovery from this procedure is also slowed among obese patients.”


Ways to Lose Weight before Surgery


As the authors of this latest research on obesity and joint replacement noted, overweight patients who are in pain from damaged joints find it difficult to exercise and lose weight. While understanding this challenge, Dr. Hohman suggests that patients might want to consider other, non-traditional, low-impact exercise and a medically designed diet.


“Patients who are obese before surgery can try to exercise prior to surgery with special programs designed to limit the pressure on their arthritic joints, such as pool therapy. A physician supervised diet can also help to reduce the level of obesity and increase the likelihood of post-operative success.”


About the Author: Over the past 35 years, Art Young has interviewed some of the most interesting people in the world and used these conversations to develop a diverse catalog of compelling stories. He is a writer, blogger, podcaster, broadcaster and frequent speaker on subjects ranging from technology to healthcare to music to outdoor sports and too many other subjects to mention. If content is king, then Art Young must be his strongest emissary.


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