Why You May Not Qualify for a Joint Replacement if You Are Morbidly Obese

Morbidly obese patients simply have not had as much access to joint replacement surgeries as their regular BMI counterparts. It is not uncommon for an obese patient to go to an orthopedic surgeon and be told to come back after they have lost weight. This is incredibly frustrating for patients who suffer from what can be debilitating joint pain. They could have been struggling to lose weight for years, and now the pain in their joints makes it difficult or impossible to exercise. They know, more than anyone, that what’s holding them back is a disease and one that is decidedly undertreated even in modern medicine.

The orthopedic surgeons denying a joint replacement to morbidly obese patients are not trying to discriminate or fat-shame. They have valid reasons backed by research as to why they don’t want to perform a joint replacement on obese patients with certain BMIs. Research has shown that obesity makes a patient less than ideal for joint replacement surgery.

The Reasons Why Orthopedic Surgeons May Not Want to Treat Obese Patients

People who suffer from obesity are at an increased risk for many diseases, including osteoarthritis. This is a type of arthritis that happens when the cartilage starts to wear down. It happens slowly and gets worse as time passes. The main symptom of osteoarthritis is pain. It can affect any joint but is commonly found in the knees, hips, back, hands, and neck. The treatments for osteoarthritis include medication, physical therapy, and surgery. Obese people with osteoarthritis are at an increased risk of needing surgery to relieve joint pain. Still, many surgeons will not do the surgery for them due to the belief that obesity makes you a poor surgical candidate. Some of the reasons why doctors believe this is because,

• Obese patients are at higher risk for surgical complications
• The joint is more difficult to expose and work on in an obese patient
• Obese patients have more comorbidities that make surgery and recovery more difficult
• Anesthesia is riskier for obese patients

Orthopedic surgeons have to decide who they think is a good candidate for surgery and who is not, and they will not perform the surgery if they don’t believe you are a good candidate. A surgeon aims to have successful surgeries with minimal operation and post-op complications. If they think obesity will get in the way of this, it is in everyone’s best interest to look for alternatives.

In addition to the orthopedic surgeon, another essential member of the surgical care team is the anesthesiologist. These doctors are responsible for keeping the patient unconscious and pain-free during surgery. Some anesthesiologists will also have concerns about their involvement in performing joint replacement surgery on obese patients for various reasons.

According to the American Society of Anesthesiologists website, “Obesity can make surgery more challenging…excess weight can put you at risk for certain side effects and complications…One of the biggest concerns is that being overweight makes you more likely to have sleep apnea, which causes you to stop breathing while you sleep temporarily. This can make anesthesia riskier, especially general anesthesia, which causes you to lose consciousness”.

The website goes on to state that some other obesity-related challenges related to anesthesia include:

• Comorbidities that complicate surgery
• Difficulty finding veins to administer anesthesia and other medications
• Difficulty determining the correct dose of medications
• Make sure the patient gets enough oxygen and airflow while under anesthesia
• Obese patients take more time to regain consciousness after surgery
• Difficulty placing a breathing tube
• Increased risk of breathing difficulties

They recommend that if your surgery is not an emergency, patients should improve their health and meet with the anesthesiologist before proceeding. During this appointment, medical history and possible complications should be discussed. ¹

The Bottom Line

Many orthopedic surgeons and anesthesiologists will decline to perform bariatric surgery on patients with high BMIs. Typically, the threshold is 40 or slightly higher. However, some orthopedic surgeons will perform surgery on patients who show a decline in BMI, suggesting that their diet or weight loss program is working.

However, reducing absolute risk is the best way to avoid the complications associated with surgery in obese patients. Patients can consider a medical weight loss program or even weight loss medication. For patients with severe comorbidities, considering bariatric surgery may be an option as well. It is also worth understanding and knowing that once you have lost some weight, you may be able to delay the orthopedic procedure because the joint pain may improve with less pressure.

Speak to our office to learn more about the various weight loss options available and how they can affect a future orthopedic surgery.

Resources:

¹ Obesity: Surgery risks & anesthesia complications – Made For This Moment | Anesthesia, Pain Management & Surgery. (n.d.). Retrieved May 20, 2022, from https://www.asahq.org/madeforthismoment/preparing-for-surgery/risks/obesity/