A recent Wall Street Journal article (Surgeons’ Weighty Dilemma, February 28, 2006) examined the challenges facing patients and surgeons regarding joint replacement in the obese individual.
Does obesity lead to arthritis of weightbearing joints? The answer is an emphatic maybe. The causes of osteoarthritis are multifactorial. Some of us are genetically preprogrammed to develop deterioration of our weightbearing joints; others, due to factors such as trauma or prior surgery, will also develop osteoarthritis. For a given individual at risk for developing osteoarthritis, two factors can influence expression of the disease: the patient’s weight and activity level. The heavier you are, the more stress you place on the compromised joint.
Once a joint has deteriorated to the point of requiring joint replacement, the obese individual presents greater challenges, ranging from exposure of the joint to placement of the components and recovery of function. A recent study reported in the Journal of Bone and Joint Surgery found that, at six and a half years of follow-up, 99% of total knee replacements were successful in the non-obese patient versus 88% successful in the obese patient.
Total joint replacement remains a very successful operation. And while there are increased risks in the obese individual, outcomes are still very favorable. In an attempt to minimize risk factors surrounding joint replacement, patients should aim to stabilize their weight, improve their overall conditioning and strength, and educate themselves on the risk versus benefit of joint replacement surgery.
