Our Summary

This research paper discusses the impact of obesity on a surgery called total knee arthroplasty (TKA), commonly known as a knee replacement. Around 35% of the US population is obese and this isn’t expected to decrease. The more obese people there are, the more demand there could be for knee replacements.

However, the information on how safe and effective knee replacements are for obese people is mixed and unclear. Before the operation, doctors need to think about how to improve the patient’s nutrition, help them lose weight safely, and whether weight loss surgery might be needed.

During the operation, it might be harder for surgeons to see and work on the knee. Also, getting the artificial knee parts to align correctly and stay fixed in place could be more difficult.

After the operation, there could be issues with the artificial knee becoming loose, complications with the wound healing, and problems with the patient’s heart and breathing.

By better understanding these potential problems, researchers can work to improve the outcomes for obese patients who need knee replacements.

FAQs

  1. What are the potential complications of total knee arthroplasty (TKA) in obese patients?
  2. What are the preoperative, intraoperative, and postoperative considerations for obese patients undergoing TKA?
  3. How does obesity impact the outcomes of total knee arthroplasty?

Doctor’s Tip

One helpful tip a doctor might tell a patient about knee replacement is to focus on maintaining a healthy weight both before and after the surgery. Losing excess weight can reduce the stress on the new knee joint and improve overall outcomes. Additionally, following a balanced diet and engaging in regular exercise can help support the healing process and prevent complications. It’s important to work closely with your healthcare team to create a personalized plan for weight management and overall health before and after knee replacement surgery.

Suitable For

Patients who are typically recommended for knee replacement surgery include those who have severe knee pain and stiffness that limits their daily activities and quality of life. This includes patients with osteoarthritis, rheumatoid arthritis, or other degenerative joint diseases. Additionally, individuals who have not experienced relief from non-surgical treatments such as physical therapy, medications, or injections may also be candidates for knee replacement.

Obesity is a common risk factor for knee osteoarthritis and may also increase the likelihood of needing knee replacement surgery. However, obese patients may face unique challenges during and after knee replacement surgery, including increased surgical risks, complications, and potentially poorer outcomes compared to non-obese patients. It is important for healthcare providers to carefully evaluate and discuss the risks and benefits of knee replacement surgery with obese patients to ensure they are well-informed and prepared for the procedure.

Ultimately, the decision to undergo knee replacement surgery should be made in collaboration with a healthcare provider based on the individual patient’s specific condition, overall health, and goals for treatment.

Timeline

  • Preoperative: Patients typically experience chronic knee pain and stiffness that limit their daily activities. They may have tried conservative treatments such as physical therapy, medications, and injections with little to no relief. After consulting with their orthopedic surgeon, they decide to proceed with a knee replacement surgery. Preoperative evaluations may include blood tests, imaging studies, and possibly a consultation with a nutritionist or weight loss specialist.

  • Day of surgery: The patient arrives at the hospital or surgery center and undergoes the knee replacement procedure under general anesthesia. The surgery typically takes 1-2 hours to complete, during which the damaged knee joint is replaced with artificial components made of metal and plastic.

  • Postoperative: The patient is monitored in the recovery room before being transferred to a hospital room or discharged home, depending on the surgeon’s preference. Physical therapy typically begins the same day as surgery to help the patient regain strength, range of motion, and mobility in the new knee joint. Pain management is closely monitored to ensure the patient’s comfort and progress.

  • Weeks to months after surgery: The patient continues with physical therapy and gradually increases their activity level. They may experience some discomfort and swelling in the knee, but these symptoms typically improve with time. The goal is for the patient to return to their normal activities without pain or limitations.

  • Long-term: Most patients experience significant improvement in their knee function and quality of life after knee replacement surgery. The artificial joint is designed to last for 15-20 years or longer, depending on the patient’s activity level and adherence to postoperative care guidelines. Regular follow-up appointments with the orthopedic surgeon are recommended to monitor the joint’s function and address any concerns.

What to Ask Your Doctor

  1. What are the potential risks and benefits of knee replacement surgery for someone who is obese?

  2. How can I optimize my nutritional status before the surgery to improve outcomes?

  3. Are there safe weight loss strategies I should consider before undergoing knee replacement surgery?

  4. What are the potential complications that may arise during the surgery due to my obesity?

  5. How will my weight affect the alignment of the implants and the durability of the implant fixation?

  6. Are there any specific postoperative complications that are more common in obese patients undergoing knee replacement surgery?

  7. Should I consider bariatric surgery before or after the knee replacement surgery to improve outcomes?

  8. How will my weight affect my recovery and rehabilitation process after the surgery?

  9. Are there any lifestyle changes or modifications I should make after the surgery to ensure long-term success of the knee replacement?

  10. What are the long-term outcomes and success rates of knee replacement surgery in obese patients compared to non-obese patients?

Reference

Authors: Martin JR, Jennings JM, Dennis DA. Journal: J Am Acad Orthop Surg. 2017 Mar;25(3):188-194. doi: 10.5435/JAAOS-D-15-00684. PMID: 28146438