As an orthopaedic surgeon who performs a significant number of total knee replacements, I have observed more frequent complications in those patients who live with obesity. Several studies have also spotlighted this trend. A recent report out of Europe pooled together data from multiple total knee replacement studies and determined that obese patients are nearly twice as likely to have a local infection after a total knee replacement, more than twice as likely to have a deep infection, and slightly more likely to require a surgical revision than those who are not obese. Obese for the study was defined as those patients with a Body Mass Index (BMI) greater 30. An example of this BMI would be a 5’8” male who weighs 200lbs, but many obese patients have BMIs greater than 35, 40, or even 50.
We have known for years that obese patients can be very happy with their total knee replacement outcome and in some cases, even more satisfied than their non-obese counterparts. Unfortunately, patients with obesity do run a higher risk for infection and they tend to have complications associated with obesity, such as diabetes and coronary artery disease. As physicians, we owe it to our patients to try to optimize their surgical results. As such, I strongly encourage weight loss for all of my patients, but particularly those contemplating a weight-bearing joint replacement. Patients who lose weight and build muscle prior to joint replacement can expect a smoother recovery following surgery.
Often, those with bad knee arthritis have will have difficulty with any exercise to lose weight. Many patients will claim they will lose weight after the knee gets replaced but research shows otherwise. (If anything, these patients tend to gain more weight with the new joint in place.) If water therapy is possible, it too may serve as an alternative exercise regimen. When exercise is too painful or the patient seems otherwise unwilling to exercise, we attempt to at least modify diet. Patients are not encouraged to rapidly diet, but we will set modest weight loss goals to be attained over time.
No one is claiming that weight loss is easy, but I believe that if more people were educated about the difference a little weight loss makes to your joints, they would better understand why it is so strongly encouraged by orthopaedic surgeons. For example, did you know that for each pound of weight you lose, 6-8 lbs of force will be taken off of your knees? A ten pound weight loss over 6 months means you’ve removed 60-80 pounds of force from your knees! Until we get it under control, America’s obesity epidemic is going to continue to strain the knees of Americans and the success rate of the valuable procedure of total knee replacement.
Dr. David T Schroder is a board-certified orthopaedic surgeon, fellowship trained in total joint replacement, with The San Antonio Orthopaedic Group. He treats patients aged 11 years and up for most orthopaedic conditions, with the exception of spinal surgery. He has a special interest in total knee replacement. To schedule an appointment with Dr. Schroder, please call 210.281.9595.
To see the study that Dr. Schroder is referencing, click here.
When your hip arthritis gets so bad that you need to discuss replacement options, there are really only two options to consider: total hip replacement and total hip resurfacing.
We can put a stem of metal into your femur (total hip replacement) or we can place a “cap” onto your femur, leaving your femoral neck intact (total hip resurfacing). On the pelvic, or cup, side, we do a similar process of placing a metal cup for each of these two choices.
After most current total hip resurfacing implants were approved about 6 years ago for use in the U.S., people jumped at the alternative to total hip replacement. As data gathered by national joint registries in Australia and elsewhere accumulated, however, it was noted that women did not do as well as men with hip resurfacing. Resurfaced hips failed more frequently in women than traditional hip replacement.
At first the difference between male and female outcomes was attributed to the fact that the smaller femoral necks in women could not support the “cap” on the femoral head and would fracture. A recent study of resurfacing out of Great Britain, however, challenges this notion. The investigators state that even women with larger femurs still fail at a rate of up to 5 times other conventional hip implants.
Additionally, hip resurfacing by its definition involves a metal head against a metal cup; a so called “metal-on-metal (MoM)” joint. These MoM joints have been under the microscope as well because of some patients having bone wear away and early failure. These types of MoM reactions by the body seem to be more prevalent in women.
Resurfacing proponents claimed improved range-of-motion, improved “feel”, even the ability to run after surgery. These claims were pushed forth by industry and some providers alike. The reality is that the outcomes are similar between resurfacing and replacement procedures. Only one subgroup has a slight edge with resurfacing when compared to replacement: muscular men aged 45-55.
In view of recent data and as a fellowship-trained joint replacement specialist (who trained with one of the top resurfacing surgeons worldwide), hip resurfacing is not an option I would offer the majority of my female patients. I think there are too many unanswered questions and we have an excellent track record with total hip replacement.
Dr. David T Schroder is a board-certified orthopaedic surgeon, fellowship trained in total joint replacement, with The San Antonio Orthopaedic Group. He treats patients aged 11 years and up for most orthopaedic conditions, with the exception of spinal surgery. To schedule an appointment with Dr. Schroder, please call 210.281.9595.
Next week, TSAOG will begin a major remodel of our main location at the Orthopaedic Institute – 400 Concord Plaza Dr, San Antonio, TX 78216. We ask that you please pardon our dust during construction and look forward to a fresher, more functional Orthopaedic Institute.
Here are a few of the things you have to look forward to:
- Our Ambulatory Surgery Center will expand to include 2 more operating rooms and an additional procedure room.
- Our main clinic space will expand to include additional exam space and a larger casting area.
- Everything will be freshened up with new paint, carpet, and finishes.
The Orthopaedic Institute will remain open at current capacity for exams, urgent care, surgery, physical and hand therapy, and imaging throughout the remodel process.
The estimated completion date for the remodel is April 2013, but we will keep you updated as things develop.
Streamlining our facilities to improve patient care is one more way TSAOG makes your health our mission.
Did you know that The San Antonio Orthopaedic Group (TSAOG) has one of the most sophisticated HD operating room systems available in our onsite surgery center?
TSAOG’s FULL HD video platform captures endoscopic (inside the body) images in a wide 16:9 aspect ratio, then displays the images on WideView™ HD monitors, providing the best possible view of video images.
What this means for our patients is that when one of our surgeons is performing an arthroscopic procedure, he can see real time, high definition footage of the area he is working on, making microscopic details appear larger than life!
This helps our surgeons deliver the exceptional care our patients expect. Viewing high-definition images with superior color, contrast and clarity during endoscopic surgery helps the surgeon accurately recognize the areas that need to be treated, captures details that might otherwise be missed, and supports positive outcomes for patients.
The new system also gives TSAOG the ability to transmit our surgeries in high def for educational purposes anywhere in the world.
Bringing you the best possible technology is just one more way that TSAOG makes your health our mission.
The Orthopaedic Surgery Center of San Antonio, located at The San Antonio Orthopaedic Group’s Central location on Concord Plaza Dr, has recently been listed in Becker’s ASC Review’s 154 Orthopedic and Spine-Driven ASCs to Know.
We are honored to be the only facility in San Antonio that made the list!
Click Becker ASC’s 154 Orthopedic and Spine-Driven ASCs to Know to read more about this listing and to see who else made the cut.