THR Bmi cutoff

[Gerard2018]

I was first diagnosed with end stage hip OA in late 2017 and told that not only to stop my running and heavy weightlifting, but also that those activities are not for those who have a hip replacement( I have since learned the may not really be the case).
I tried other activities, and nothing really got me interested, so I really stopped exercising. At this time, I also meant my soon-to-be wife, who was a pastry chef, who loved to cook big meals, like her Italian grandmother, and make sure her husband is well cared and shown love by making sure that he is well fed, like her Alabama up bringing told her to.
Needless to say I got fat. Very fat, at 5’9, and 403 lbs, with much of the 225 pounds gained since 2020, the year where I felt like some character from a Ronald Dahl story being fatten’d up on purpose with the way my wife went mad in the kitchen when she lost her job, and she decided to stay home and make me the sole customer of he baked goods lol.
As this is the last year at my current job, which has very good health insurance, I have been thinking about having my hip done, even though I can still walk two miles a day, albeit it with some pain, but nothing that is too unbearable. In fact, even though I have gained all this weight, my pain level is much, much better than when I was crazy active. And all my blood work is fine, hr and bp are fine, which I think is because I am still walking.
But I have been told by surgeons that just being big makes it hard to place the hip in there. Is that true?
I was also told that I am at a greater risk of infection due to my obesity. But even if that is the case, then since elderly people are at greater risk of infection too, we should no longer do it on anyone over 65. It does not make sense.

 

[benne68]

HI, @Gerard2018. Here's some reading that you may find helpful:

BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery

 

[Sockeyewillie]

Hi Gerard, I just had a revision of my right THR. My initial THR was May 4, 2020. At that time I was 6’ and 310 lbs. I recall hearing my wife say the surgeon tell her that they really had to do a lot of work dislocating my leg and exposing the femur. I remember, vividly, reading the operation report and reading that the patient presents as a morbidly obese male. I carried that weight through my recovery and PT. My recovery was difficult, I had lots of pain and was on opioids for a month. I never completely felt the pain of the surgery leave and one year later January 24, 2021 through a series of social media coincidences a began a new journey. Over the next 10 months I immersed myself into the carnivore lifestyle. I never cheated and ate an incredible amount of fatty meat. At the end of that 10 month period I had lost 100 lbs. all with “zero” exercise. I got a puppy and we walk several miles a day. I continued with the lifestyle and have kept myself at 190 lbs ever since and I had never felt better, except for my hip, specifically the femoral post. After lots of imaging we decided on a revision May 18, 2023. The revision took less than 2 hours, I stayed one night in the hospital and am off opioids today 4 days later and using a cane instead of a walker. Being in shape and having a diet without sugars and carbohydrate has made my recovery much better.

 

[Jamie]

@Sockeyewillie …. Congratulations on your new lifestyle and impressive weight loss. Each of us has to follow the path that works for us and our bodies. The only thing I would say as a caution for anyone attempting to lose this much weight, is to do so with your GP’s support. All diets can have risks for some individuals and it’s important to coordinate it with your doctor who can ensure that the weight loss is accomplished in a healthy way.

Good for you for getting a puppy to assist in your new lifestyle! I’m sure all that walking is a key to you maintaining a more healthy weight. I hope your excellent recovery from your revision continues.

 

[Jamie]

@Gerard2018 …. Good for you for keeping up a good relationship with your GP even though you’ve experienced a significant weight gain in the last few years. Obviously it would be better if you weren’t carrying all that weight, but it is important that you’re active with a good blood pressure and heart rate.

As for your concerns about having a hip replacement, at a BMI level of 59.5, you may find your options for a surgeon significantly limited. Most doctors (and insurance companies) require their patients to have a BMI of 40 or less.

It is more difficult to do a hip replacement when a person is obese. It’s a very physical procedure for the surgeon and medical team as your leg is moved in a lot of different ways to dislocate the old joint, position the new implant, and test its function before completing the surgery. When you are under anesthetic, your leg is “dead weight” and very heavy. They also must make special accommodations to work around the fatty tissue and skin folds that make the operation more complex. There are surgeons who will do this, but you may have to travel quite a distance to find one. But, even knowing there are surgeons who work on high BMI patients, I’m not sure how many would attempt someone of your weight.

Infection is a greater risk for obese people as well. It partly has to do with the way the skin folds hang on an overweight person. They can obscure the incision area and not permit good air circulation. Also, the presence of a lot of sugar and carbohydrates in your system can encourage bacterial growth in some people. Adipose tissue has reduced blood flow and this can lead to slower healing. Slower healing allows a greater chance for infection to develop. You cannot compare this higher risk for infection to the decline in a person’s immune system as they age. A person’s immune system peaks around the time of puberty and slowly declines after that. But it’s not as great a factor in surgical outcome until much later in life when a person is healthy with no comorbidities. Healthy older adults do just fine with joint replacements. As people age and develop comorbidities such as diabetes, heart and lung problems, and other health issues, the risk for infection increases.

 

[Roy Gardiner]

through a series of social media coincidences a began a new journey. Over the next 10 months I immersed myself into the carnivore lifestyle. I never cheated and ate an incredible amount of fatty meat. At the end of that 10 month period I had lost 100 lbs. all with “zero” exercise. I got a puppy and we walk several miles a day

I suspect that 'social media coincidences' and 'new journey' are modest reportage of extensive research on the new way of eating. Also, going from 'zero' exercise to walking several miles a day will have strong effects, too.

Congratulations on your new lifestyle and impressive weight loss. Each of us has to follow the path that works for us and our bodies. The only thing I would say as a caution for anyone attempting to lose this much weight, is to do so with your GP’s support. All diets can have risks for some individuals and it’s important to coordinate it with your doctor who can ensure that the weight loss is accomplished in a healthy way.

I absolutely agree with Jamie; many very low carb diets (e.g. Atkins) have potential health impacts. At the other extreme, a family friend of mine went totally vegan and very nearly killed himself from vitamin B12 deficiency.

In the UK the famous/notorious Bear Grylls went vegan -> carnivore, too, https://www.gq-magazine.co.uk/fitness/article/bear-grylls-diet-2022

 

[Sockeyewillie]

A couple of things to note. The walking came 14 months after the weight loss as the result of a new puppy. The only effect was the weight loss allowed me to walk distances I hadn’t been able to with 110 lbs on my frame.
I have had zero negative effects. My arthritis is gone, acid reflux gone, snoring gone, heart attack risk ratio cut in half, skin condition gone. ED problems gone and then some.
Wait, I have thought of something. I spent a fortune on new clothes.

 

[Roy Gardiner]

Thanks for the update. No criticism was intended, rather the opposite with such profoundly good results.

 

[Jamie]

I agree with Roy. Your experience is one for the record books. So glad this has worked out for you and you are healthier!