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

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