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OBESITY
DETAILS
More reasons to loose excessive weight before your total
joint surgery:
Statistics show that obese people get more often
postoperative infection, thrombosis (formation of blood clots), and other complications
from the circulatory organs after total joint replacement operation.
Losing excessive weight before the total joint surgery has
also other positive effects:
it would enable your surgeon to use smaller incision, with
less bleeding from the operative wound
it will reduce the possible problems with anesthesia
it will speed your recovery because the postoperative
rehabilitation will be much easier.
Perhaps you are reasoning that once you will have a new
pain-free total joint, you will be able to loose your overweight more quickly?
Unfortunately, statistics showed that after a successful total hip / total knee
operation only 20 % of obese people managed to reduce their weight. So start losing
overweight before the surgery.
Can obese patients have a successful total
hip / total knee replacement?
Yes. But recent studies also demonstrated that
overweight patients have had twice (men) or thrice (women) higher risk to develop
osteoarthritis of their hip joints than normal weight patients. This risk increases
with increasing overweight. (Flugsrud 2002)
The risk of failure of the total hip operation was
also higher in these overweight patients. In excessively overweight patients this risk is
very high (Marks 2002)
Although obese patients put more weight / stress on their
new joints, the obese patients are walking and exercising significantly less after the
total joint operation than their lean colleagues. Thus, the sum of all stresses put
by the overweight patients on their total joints seems not to be much greater than
the total stress produced by the lean patients.
Thanks to special hormones (leptines) produced in the fat
tissue, the skeleton of obese patients is usually very strong. These patients are often
candidates for cementless total joint prostheses. Thanks to the strong skeleton, the total
joints usually find good hold in the skeletons of overweight patients with osteoarthritis.
Research showed, that obese patients enjoy as much
improvement and satisfaction as other patients from total hip and knee surgery.
Unfortunately, the research also shoved that obese patients have much more difficulty with
ascending stairs and with other forms of motion after the surgery than their lean
co-patients. (Stickles et al.)
Very obese patients, however, usually cannot have total
joint replacement operation until they reach acceptable body weight. The rate of
postoperative complications such as deep infection, fractures, etc. is very high in these
patients.
Sometimes the only means for such patients to get
down in weight is abdominal surgery. Studies demonstrated that excessively
overweight patients, who have had successful surgical treatment of their overweight first,
may reach excellent results after total joint replacements.
What is overweight? - The doctors usually calculate
the body mass index (BMI). Values up to 25 are within normal, values between 25 and 30 are
considered as overweight, and values over 30 denote excessive overweight
To calculate your BMI, take your body weight in kilograms
(BW) and divide it with your squared height in meters (SQH).
BMI = BW / SQH
For example, a patient who weights 120 kilograms and is 173
cm tall
has a BMI of (120 / (1,73)2
) =
(120 / (1,73*1,73)) =
= 40
He / she is definitively overweight.
A Table for your help
| HEIGHT in cm |
WEIGHT in kg |
| |
Obese |
Excessively obese |
| 155 |
60 -72 |
>72 |
| 160 |
64 - 77 |
>77 |
| 165 |
68 - 82 |
>82 |
| 170 |
72 - 87 |
>87 |
| 175 |
77 - 92 |
>92 |
| 180 |
81 - 97 |
>97 |
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Reference:
Flugsrud GB, et al.: Arthritis Rheum 2002;46: 675-82
Marks R., Alleggrante JP.: Arthritis Res 2002;4:
112-6
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