Obesity, Weight Loss, and Joint Replacement Surgery

Patients with obesity are frequently advised to lose weight prior to total knee or total hip replacement. The reasons for this recommendation are numerous:

• Patients with obesity (BMI >30) are 1.7 times more likely to have complications after total joint replacement compared to patients with a BMI <30.
• Patients with a BMI >35 are 2.2 times more likely to have complications.
• Patients with a BMI >40 are 3.7 times more likely, and those with a BMI >50 are 21 times more likely to suffer complications.

Pre-surgery

Obesity is associated with many known risk factors for any surgical procedure. These include:

• Cardiovascular disease, including hypertension
• Type 2 diabetes
• Obstructive sleep apnea
• Metabolic syndrome
• Adiposopathic (sick fat disease) chronic inflammation
• Polypharmacy

Surgery

Obesity can also cause complications during surgery.

Challenges for the anesthesiologist may include:

• Locating proper venous access to administer general anesthesia and medications
• Alterations in body shape and anatomy that interfere with adequate oxygenation and airflow
• Proper needle positioning for delivering regional anesthesia (e.g. spinal and epidural nerve blocks

Obesity may also cause increased operative times due to technical challenges. The longer a surgery, the greater risk of complications. Obesity also increases the risk of nerve injuries and blood loss.

Post-surgery

Obesity can also increase complications after surgery:

• Infection and sepsis- studies have shown that patients with obesity have double the rate of infection following total knee arthroplasty
• Poor wound healing
• Deep vein thrombosis
• Pulmonary embolism
• Dyspnea and hypoventilation
• Prosthetic component loosening and failure due to biomechanical stress
• Dislocation of the joint replacement (especially the hip)
• Decreased joint mobility and range of motion compared to patients with healthy weight
• Difficulty participating in active rehabilitation due to an altered center of gravity and impaired balance
• Challenges with postoperative pain management

Our expertise is helping patients lose weight quickly so they are in optimal health prior to joint replacement. For additional expert information on obesity, please visit us at https://www.scottsdaleweightloss.com