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Discussion in 'Pre-Surgery Information' started by Jamie, Sep 10, 2012.
I use this one
It can happen.
You meet with your surgeon and he tells you that you're just too heavy for a successful outcome with joint replacement surgery. "Lose some weight first, " he says. "Then come back and we'll discuss it."
You leave feeling sad, hopeless and wondering what to do next. You'd love to lose weight, but it's almost impossible to stay with a consistent exercise program because your joints hurt too much.
So what now???
The best course of action is to get busy and find a new surgeon who is more understanding of the problem. There are many who will perform knee or hip replacements on obese patients. If you're in the USA, use the BoneSmart FIND A CLINIC locator (tab at the top of the page) to find potential surgeons within whatever distance you are willing to travel. If you're in the UK, post your location with a tag to our forum nurse, Josephine, and she can help you locate a surgeon. If you're in another country, find all the orthopedic surgeons in your area and contact them.
Their websites won't mention whether or not they work with overweight patients, so call as many on your list as possible and ask if the surgeon is comfortable working with someone of your size.
Before you begin your search, it helps to be armed with information. The posts in this thread will provide data to assist in your search. Most surgeons will want to know your Body Mass Index (BMI), so calculate that before you start calling clinics. Be prepared to tell them if you have gained a significant amount of weight BECAUSE of your bad joint(s). Let them know how much weight you've gained and in what period of time. Also, talk about your willingness to begin a healthy life program once you are pain free.
In this thread, you will also find an article supporting the argument that weight is not a factor in how well someone will do after joint replacement surgery. While there may be some additional days spent in a hospital unit where you can be carefully monitored for possible breathing or heart issues, the performance of your new joint will be much the same as any other patient.
Hopefully we will be able to provide more research results for you in the future.
What you must do is NEVER give up hope! Many folks before you have had successful hip or knee replacements and have gone on to happy lives with their new joints. There is a surgeon out there who can help you. You just have to find him! We're here to help as much as we can in your search.
From Roy Gardiner:
There are any number of BMI calculators on the net. The ones I have seen require you to convert your height and weight to metric. But that is what computers are for! So I have created one that allows you to enter either metric or Imperial measurements to your choice
Here's what the screen looks like: http://www.roygardiner.com/images/bmiscreen.jpg (link rather than image because it's quite big).
To use it it's here amongst other cycling related calculators, scroll down until you find it: http://www.roygardiner.com/gears.htm
Patients with high BMI show similar improvements in patient-reported outcomes after TKA
September 4, 2012
Researchers from the United Kingdom have reported similar improvements in patient-reported outcomes after elective total knee arthroplasty regardless of patient body mass index, according to a recent study published in the Journal of Bone & Joint Surgery.
Paul N. Baker, MBBS, MSc, FRCS(Tr&Orth), and colleagues analyzed patient-reported outcome measures of 13,673 primary total knee arthroplasty (TKA) procedures from the National Joint Registry preoperatively and 6 months postoperatively. Patients were divided into three groups based on body mass index (BMI). Obese patients in the group with a BMI between 40 and 60 kg/m² had similar Oxford Knee Score, EuroQol 5D index and EuroQol 5D VAS scores postoperatively compared to patients with a BMI between 15 and 24.9 kg/m², according to the abstract.
“Patients achieve equivalent improvements in knee function and general health irrespective of their preoperative BMI,” Baker told ORTHOPEDICS TODAY. “Obese patients gain as much benefit from knee replacement as patients with a ‘normal’ BMI, even if they do not end up at a similar postoperative level. Accordingly, we feel that the obese should not be excluded from the benefit experienced by their fellow patients with lower BMI from undergoing total knee replacement.”
Although patient-reported outcomes in the group with the highest BMI were similar, the group had significantly higher wound complications than the patients with “normal” BMI, Baker and colleagues noted. The study comes as a response to recent legislation in the United Kingdom that would limit access to total knee arthroplasty (TKA) procedures for patients with a BMI > 35 kg/m², according to Baker.
“The current situation in the UK is that the responsibility for health budgeting has devolved to the primary care physicians and their associated primary health care trusts. From the money allocated to them, they are responsible for purchasing services from hospitals for their patients,” Baker said. “Certain health care trusts have refused to pay for knee arthroplasty procedures in patients above specific BMI thresholds due to a perceived reduction in risk/benefit in this group. Our argument is that these thresholds are completely arbitrary and lack any evidence to support their use.”
Baker P, Petheram T, Jameson S, et al. The association between body mass index and the outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2012; Aug 15