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Old 06-20-2006, 05:45 PM   #1
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Default Knee replacement surgery while obese?

I'm curious if anyone here has had (or known someone who has had) knee replacement surgery while obese? My Dad has suffered from terrible arthritis-related pain for decades and he is very obese - I believe around 320 pounds/5'10". The last doctor he saw (about 5 years ago) said he needs a replacement, that it was "bone-on-bone", but that they wouldn't do surgery on someone with a BMI as high as his. I understand that the complications to any surgery are higher when you are overweight and given the weight bearing nature of this one, would make recovery longer. But, is it really true that they do not do knee replacements on obese patients? He cannot walk without pain now - and by evening he is miserable. Exercise is not even an option for him at this time. (I have mentioned swimming, but he doesn't do it...) He tries to lose weight just by portion control and he'll do good for a few months and then slip up and gain weight again. I feel so bad. And I want him to get a second opinion. Anyways, that got kinda long. Just curious if what this doc said really is the case - it seems like there must be so many obese patients who need or have had the surgery.
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Old 06-20-2006, 06:13 PM   #2
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Hi Nori!

A second opinion is always a good idea, especially when you're considering major surgery.

I have severe osteoarthritis in both knees and am bone on bone too, so have been forced to learn about knee replacements (though I'm trying to stall as long as possible!) My doctor and I talked about the weight issue since I used to be morbidly obese and undoubtedly did a lot of damage to my knees during those years that can't be undone. (Note: I could just kick myself for being so stupid and not losing the weight sooner!!)

Anyway, yes, 300 pounds seems to be the cut-off for knee replacement from what he told me and I've read. I think the problem is that the artificial joint can't support more weight than that - it's a mechanical problem rather than a healing problem. My doctor explained to me that every extra pound that we carry exerts four pounds of pressure on our knees, ankles, and feet and even just a few excess pounds can cause major problems. So every additional pound would also exert four pounds of force on the artifical joint and it just can't handle it.

I'm no expert by any means, so take this with a grain of salt! But I do run across obesity as a counterindication to knee replacement in most of my readings, so I don't think it's just your dad's doctor.

The advice I was given on preserving my knees for as long as possible is: 1) exercise to strengthen the muscles that support the knee and 2) maintain a normal weight. There's really lots your dad could do! There's swimming, of course, for cardio as well as stationary biking - that's very good for the knees. I can still do the elliptical but imagine that would be too much for him to start. Then there are leg strengthening exercises that he could do such as leg press, leg extensions, leg curls, squats with an exercise ball - most of these are done seated and none involve impact.

I truly believe that exercise is the only thing keeping my knees going at this point! I can actually hear the bone rubbing on the bone when I walk (gross!) but still do an hour of non-impact cardio every day and a pretty strenuous leg workout twice a week. My legs are ridiculously strong and have created a kind of internal brace for the bad knees. Honestly, ANY exercise that your father does would be helpful!

Do you live near enough that he could exercise with you? It's so much easier to start out with a buddy! Would he accept your help with a healthy diet plan? Perhaps if he lost just 10 or 20 pounds and started to feel the difference, he'd be motivated to continue.

Best of luck to the both of you.
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Old 06-20-2006, 06:26 PM   #3
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More on weight and arthritis:

Small Weight Loss Takes Big Pressure Off Knee

Quote:
Researchers say the results indicate that even modest weight loss may significantly lighten the load on your joints.

"The accumulated reduction in knee load for a 1-pound loss in weight would be more than 4,800 pounds per mile walked," writes researcher Stephen P. Messier, PhD, of Wake Forest University in the July issue of Arthritis & Rheumatism. "For people losing 10 pounds, each knee would be subjected to 48,000 pounds less in compressive load per mile walked."
That's amazing! And it also might explain why knee replacements might not mechanically be able to handle the weight of obese people.
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Old 06-20-2006, 06:54 PM   #4
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My husband is around 360, and his doctor told him that he wasn't a good knee replacement candidate for two reasons. He was too young, and weighed too much. He said that a knee replacement lasts about 10 years (some of the new ones are lasting much longer, but this is the average), and that at his weight, it would only last five or six years at most. No surgeon would operate under those circumstances, because by the time the knee was fully healed, it would already be starting to deteriorate.

It is very difficult to stay motivated when the weight is so hard to take off, and it is difficult to stay motivated when you have so much to lose, and are losing it so slowly. And when pain prevents you from doing much exercise, it's even more difficult.
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Old 06-20-2006, 07:52 PM   #5
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Knee replacement also has a long rehabilitation time. My MIL had both her knees done, and was in PT for about 4 months. I'm with Meg - putting it off as long as possible. My knees really do feel better when I exercise regularly, and losing weight certainly helps a lot. Another problem is that obese people often have problems with anesthesia and as such are sometimes not considered good surgery candidates, esp as we get older.

Keep encouraging your Dad. He will likely feel better if he loses some weight, and even if he doesn't, he'll be a better candidate for the replacement surgery.
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Old 06-20-2006, 09:23 PM   #6
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I don't know where the cutoff would be, but my daughter, over 250 lbs., has had tissue replaced in her knee and my dad, over 270 lbs, had knee replacement surgery...along with half a dozen other knee surgeries. He has serious diabetes and a knee injury that happened many years ago in the coal mines. Maybe he HAD to have the surgery regardless of weight, or it's that he's not on his feet much. Or perhaps they just have some cutoff limit.
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Old 06-22-2006, 12:52 AM   #7
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Thank to you all for such informed and knowledgeable input! I passed on this information to my Mom and they are planning on going to get a second opinion. As far as diet, my Mom has been following The Zone for years, and when my Dad is being "good" he does as well. I just wish he could find something he could stick with...
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