There is a range of accepted weight ranges, but the current standard is that anyone obese (greater than 100 pounds over ideal weight or a BMI of roughly 40-45) should not consider joint replacement.
Because of these increased risks, some surgeons, hospitals, and insurance companies have adopted BMI cutoffs above which they recommend against joint replacement surgery to limit the risk of complications in patients with higher BMIs. These cutoffs often match obesity classifications at BMIs between 35 and 40.
Twenty pounds “is the magic number based on our evidence,” Keeney said. “This is even after accounting for age, gender, and other diagnoses besides obesity, as well as baseline physical and mental function.”
A BMI over 25 is termed as being overweight and over 30 is termed as being obese. There can be a higher risk of surgical and anaesthetic complications if you have a BMI over 30. If you lose even 5 to 10% of your weight, this could reduce some of the risks associated with anaesthesia.
The chances of a knee replacement are 8 times higher for patients a BMI greater than 30 and 28 times higher for patients with a BMI over 35.
Medical practitioners have long advised patients to lose weight before knee surgery. Patients living with obesity, defined by a body mass index (BMI) of 30 or higher, are especially warned of surgical complications, risk of infection and poor outcomes due to their high BMI.
According to Dr. Bedard, patients with morbid obesity who do not experience any complications post- TKA or post- THA do as well as patients with lower BMI after surgery, experiencing good outcomes, including decreased pain and improved function.
There is no weight limit for surgery, per se. If one needs life-saving surgery, surgery will be done independently of a patient's weight. However, being obese or morbidly obese increases the risk for complications from anesthesia and surgery alike, especially in an emergent situation.
One of the biggest concerns is that being overweight makes you more likely to have a condition called sleep apnea, which causes you to temporarily stop breathing while you sleep. This can make anesthesia riskier, especially general anesthesia, which causes you to lose consciousness.
Learn your body mass index
A BMI range of 18-24.9 is considered optimal. Morbid obesity is defined as a BMI score of 40 or more. You typically qualify for bariatric surgery if you have a BMI of 35 or greater, with specific significant health problems like Type 2 diabetes, sleep apnea or high blood pressure.
There is a thinking among many that after the knee replacement, their physical activity levels and weight will improve. This does not appear to be true for some as research points out. In many knee replacement patients, weight loss does not occur even though activity can be increased.
Only 7% to 9% of normal weight individuals lost weight, whereas 33% to 35% of extremely obese patients lost weight. Regardless of BMI or body weight prior to surgery, 9% to 16% of people gained weight after their surgery.
The average hospital stay after total knee replacement is three days and most patients spend several more days in an inpatient rehabilitation facility. Patients who prefer not to have inpatient rehabilitation may spend an extra day or two in the hospital before discharge to home.
Many hospitals or surgeons are reluctant to do a joint replacement on patients with a BMI above a certain limit. Often, this limit is a BMI over 40.
As knee arthritis progresses, the knee becomes much looser and more unstable. In some cases, this is mild. In other cases, it is substantial enough that cause the patient to fall. Patients who have bone-on-bone arthritis and are starting to fall because of it should strongly consider surgery.
Gastric sleeve surgery is best for people who have a BMI (body mass index) of at least 35, which means you're 80 pounds or more over your ideal weight. Revision Surgery - We also perform revision surgery for several bariatric procedures.
Obesity can lead to obstruction of the airways, which can increase risks from anesthesia. Some patients will need to see an anesthesiologist prior to surgery to develop an optimal anesthetic plan. High blood pressure and high cholesterol, often seen in obese patients, also increase anesthesia risks.
Most operating tables are designed for patients of up to 120–140 kg in weight. For those who weigh more than this limit, specially designed tables may be needed. Position should be maintained to prevent nerve compressions and pressure sores.
You could be a candidate for surgical weight loss if you meet any of the following criteria: You are more than 100 lbs. over your ideal body weight. You have a Body Mass Index (BMI) of over 40.
Some patients are required to lose 10 percent of their weight before weight-loss surgery is performed. For other patients, losing just 15 to 20 pounds right before surgery is enough to reduce the risk of complications. It's important to follow your surgeon's pre-surgery diet and nutrition guidelines.
You may NOT be a good candidate if:
Your knee symptoms are not related to joint disease. Your weight is too much for the artificial joint to support. You have fragile skin or poor skin coverage over your knee. You have a severe illness or infection.
Excess weight also contributes to osteoarthritis because fat cells release chemicals that cause inflammation. These factors can contribute to the development of the disease. The more fat present in your body, the higher the concentration of these inflammatory factors that can increase joint deterioration.
The most common knee problem for individuals with obesity is knee osteoarthritis, which is caused by knee cartilage degeneration. Once the cartilage is sufficiently worn down, the bones of the knee will begin to rub together, creating friction. This friction can wear down portions of the bone in the knee.