Obesity and Orthopedic Surgery

By Robert Swift, D.O. | Board Certified Orthopedic Surgery and Sports Medicine

Obesity affects millions of Americans. Over the last couple of decades, it has spread from the adult population to adolescents and children. Although it is often attributed to poor eating habits and a lack of exercise, the truth is really a bit more complicated than that. The process by which the body converts food into energy can be influenced by chemicals in the environment, over which we have little control, and by genetics, over which we have zero control. It is a complex combination of genetic susceptibility, biological pathways related to metabolism and body weight regulation, and environmental factors.1

World Health Organization Fast Facts on Obesity
. Worldwide obesity has nearly tripled since 1975.
. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
. 39% of adults aged 18 years and over were  overweight in 2016, and 13% were obese.
. Most of the world’s population live in countries where overweight and obesity kills more people than underweight.
. 39 million children under the age of 5 were overweight or obese in 2020.
. Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
. Obesity is preventable.2

Obesity and orthopedic conditions
Obesity is a growing concern in the health community because of the morbidities associated with it. There is also a higher occurrence of many orthopedic conditions among obese individuals than their non-obese counter parts. Obesity also worsens the progression of many of these orthopedic conditions. Studies have shown that obesity may have a negative impact on bone metabolism and may be implicated in the pathophysiology of some orthopedic conditions like osteoporosis, fractures, osteoarthritis and many soft tissue ailments by both reduction in bone mass and elaboration of proinflammatory cytokines. These contribute to preponderance of musculoskeletal co-morbidities among obese patients. Critical peri-operative issues which include increased cardiopulmonary risks, issues of special equipment, instrumentation, surgical approach, patients’ positioning and adjustments in medication should be acknowledged and meticulously addressed in operative management of orthopedic conditions in obese patients. Surgeries in obese patients are fraught with operative challenges and post-operative complications than in the non-obese and a good knowledge of the critical issues in surgical management of obese patients is necessary to facilitate decision making as well as rendering of effective and efficient orthopedic care.2

Does obesity exclude a person from orthopedic surgery?
Obese patients sometimes hear from their doctor that in order to undergo a needed orthopedic surgery, such as a knee or hip replacement, they’ll need to lose 50, 75, or even 100 pounds. And sometimes the recommendation is to lose even more, as if that’s an easy or realistic prospect. While the surgeon’s recommendations may be disappointing, the rationale seems sound: people carrying a lot of excess weight have long been considered at higher risk for complications, and less likely to experience the profound pain relief expected from this major operation. Indeed, several studies describe higher rates of infections and dislocations and lower rates of good results after hip or knee replacement among the obese, especially the severely obese.

But there is promising news. The studies that doctors have long relied on to back up their recommendations were conducted decades ago. Newer studies are showing different results. The researchers conclude that “obesity in itself should not be a deterrent to undergoing total joint replacement to relieve symptoms.” However, the potential for more complications must be considered as well, something this study did not formally examine.

Given the high and rising rates of obesity and arthritis in this country, the results of this study will likely apply to many people. And they suggest that surgeons should change expectations about what surgery has to offer obese individuals with severe arthritis.

Here are some of the new findings:
• Those who were the most obese (about 25% of those in the study) had more pain and poorer function prior to surgery than those who were leaner.
• The amount of functional gain in obese individuals six months after joint replacement was significant, and similar to that experienced by those who were not obese.
• Pain relief was greater among the most obese than other weight groups. After surgery, pain levels were similar in all weight groups.3

The bottom line is that obesity should be avoided. That is always going to be true. Obese patients DO need to lose weight and obesity CAN cause significant complications during and after surgery. However, this new study is at least promising. There is hope of relief for patients suffering from orthopedic conditions that limit their mobility.

BLUE SKY ORTHOPEDIC
(239) 877-4662 | www.drrobertswift.com

4513 Executive Dr., 2nd Floor, Naples, FL 34119

 

References:
1. Obesity, National Institute of Environmental Health Sciences. U.S.
Department of Health and Human Services. Available at:
https://www.niehs.nih.gov/health/topics/conditions/obesity/
index.cfm.
2. Obalum DC;Fiberesima F;Eyesan SU;Ogo CN;Nzew C;Mijinyawa M;
A review of obesity and orthopaedic surgery: The critical issues,
The Nigerian postgraduate medical journal. U.S. National Library of
Medicine. Available at:
https://pubmed.ncbi.nlm.nih.gov/23064175/.
3. Robert H. Shmerling, M.D. (2021) Is obesity a reason to avoid joint
replacement surgery? Harvard Health. Available at:
https://www.health.harvard.edu/blog/is-obesity-a-reason-to-
avoid-joint-replacement-surgery-2019041216404