Am I Too Heavy for Hip or Knee Replacement Surgery (elevated BMI)?
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- Опубликовано: 17 окт 2024
- In this episode the surgeons answer a viewer question "Am I too big to replace my hip or knee?" They discuss the risks and benefits of joint replacement surgery in individuals with an elevated BMI. They discuss how to calculate your BMI.
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I am a 56-yr old Chemical Engineer now about 8-wks shy of my 2nd TKR surgery (thankfully not the same knee). I am 5+ years removed from my first TKR on my left knee and what a life-changing experience that was going from a misery index of about a 10, all the way down to a 1 with the new knee. This time around, I once again showed up at my initial consultation exceeding their max allowable BMI of 40. I was going good there for a few years after my first TKR but the osteoarthritis kicked in on my right knee and the pain pretty much knocked me off the exercise regimen about a year and a half ago. Unfortunately, after I could no longer exercise because of the pain in my right knee I kind of 'threw in the towel' on my diet and ballooned in weight. When I showed up at my 2nd consultation (with the same surgeon, btw) and requested a new TKR on my other (right) knee, my Doc didn't much flinch and, after seeing my x-ray, agreed the knee needs replaced. His one ask at the consultation was that I need to drop 30-lb in order to qualify for the surgery. Apparently, they've gotten serious about the BMI hard-cap of 40 and I swore to myself I'd shed the weight one way or another, as I've lived the osteoarthritis hell years ago and I'm not about to relive that nightmare again. One of my smarter moves at this latest consultation was my asking for a cortisone shot, which pretty much erased the pain (temporarily - 2 or 3 months) and allowed me to get back into the exercise swing to go along with a subsequent drastic change in my dietary habits. At the 10-wk pre-op mark, I'm now just under a BMI of 40 but plan to pad my numbers and lose as much as I can heading into my formal weigh-in in late October. That hasn't gotten easier in the past few weeks as I'm now back to exercising with the recurring pain in the right knee now that the shot has worn off and they've told me they don't like giving shots inside of a couple months of surgery as it reportedly increases the risk of infection. Nevertheless, I'll suck it up and deal with it for now as I'm 'in it to win it' at this point. I know each patient is different, but I'll say this - if my upcoming TKR surgery goes anywhere nearly as well as my first one, I'm confident I'll be set for life and won't have any reason or excuse at all to not keep with the exercise lifestyle and maintain a healthy weight following this surgery.
I was given my surgery dates for two knee replacements in November of 2023. I am an obese 70 year old woman. On January 1st of 2024, I started on a weight loss program and as of July 2024, have lost 30 lbs with diet only as I could not exercise. It is astounding to me how my knee pain subsided at about the 20 lb weight loss stage! I am having my first knee done this month (August 2024) and the second one done in December 2024. I fully intend to keep up with the weight loss battle. It most certainly isn’t for the ‘weak of heart’ but if you want to loose weight, you can.
I had a very, very successful total hip replacement with a BMI of 37. On my first visit to the surgeon, I asked if I was too heavy to get the surgery and he didn't think twice about it and said no, I was not too heavy. There wasn't even a question that I could have the operation. I was in such horrible pain, the surgery gave me a whole new life. Don't be scared off of seeking out a surgeon to do joint replacement; the pain is too injurious to your whole life.
Hi Sally. We agree with you. Most surgeons operate on a lot of people with an elevated BMI and patients can do very well. Thanks for sharing your story and so glad you have done well. Thanks for watching
A very good discussion of a difficult and complicated issue. I was close to 500 lbs, with my knees in terrible pain. When I was down to 375lbs my surgeon told me to lose 75 more pounds. I told him I would be back. I did lose the weight and in 2017 had two separate surgeries. I worked hard during rehab and when done got my self a trainer and committed to a fitness program. I love how I feel and at 68 have energy and stamina. The morale of the story is that BMI is not the only criterion that she be addressed.
Congrats on your hard work keep it up . But on the flip side this dr had a patient who had lost 175 lbs and was to months from September hip surgery in the summer the months of July and August regained it back plus 30 more while the dr was on vaccation in August basically the dr told this person not to shadow his office door way till he lost 200 lbs .thought you like that one it did actually happen
Hi Joseph and mj. Thanks for sharing your stories. We agree that losing weight is important but it is not the only things. We encourage our patients to lose weight before surgery but not a specific number. You should lose as much as you can. We will often see patients multiple times before surgery and if they have lost 10 or 20lbs we ask them how they are doing. Some patients say they want to try and lose more before surgery. Others feel like they have done all that they can and that's ok. Every patient is different. Thanks for watching and subscribing if you did.
My ortho doc is willing to work with bariatric patients for knee replacement surgery because he feels everyone deserves to get back to being mobile. He was very honest, as you are, about issues, but he encouraged me to have the surgery. I had both knees replaced in 2008 & 2009 and while I am still overweight, I am mobile and fairly healthy at 68 yrs old today.
Keep giving great advice and stay empathetic to your patients! 💖
Thanks so much KathyDNJ. It is important for surgeons to recognize that some patients will continue to struggle with weight and that is not a reason to deny them surgery. Glad to hear you are enjoying your knees. Thanks for watching and subscribing if you did.
I have 5 to 6 lbs to take off and it is Xmas time. Having a hip replacement Jan 18th anterior approach. I have to watch sugar. Love that ice cream. Thank you for helping me again. 😂
higher risk, but how aften does something actually happen?
I just had bilateral knee replacement. My surgeon wanted me to lose 15 pounds prior to surgery. I lost 25 pounds and am glad I did. It definitely is helping in my recovery. As I start moving more, I hope to lose another 25 pounds. Our knees were not built to carry extra weight.
Hi marion. That is amazing! Congratulations and continued good luck. Thanks for watching.
Thank you for a truly not fatphobic and frank discussion about BMI and joint replacement. I was just denied by 2 doctors purely by BMI and was devastated. I'm embarking on losing weight now and finding other ways to exercise since my AVN is severe and my femoral head has collapsed. This is a video I can send to my family and friends that doesn't rely on fatphobic nonsense. As a science teacher with a molecular/cellular biology and dietetics degree, I get frustrated with the use of BMI, but also recognize the risks that a larger body can have in the surgical setting. Thank you!
Very welcome. AVN can be very painful. Losing weight is hard. If you feel like you have tried everything, consider a whole food plant based diet. Watch “what the health” on Netflix and “forks over knives” at their website. Will change your life
Were you able to have your hip replacement?
Wow, you handled that rather difficult question most diplomatically! Well done, and spot on!
Thanks Chryseas. It is a big (no pun intended) problem that affects a lot of people. Everyone needs to do their best. That's all they can do. Thanks for watching
My bmi is 39 and it’s taken me 3 different orthopedic surgeons to finally help me. My life is so dormant because of the pain. Two years of knee injections and pt has not been effective. I’m finally getting surgery in May 2022; I’m nervous but I’m in too much pain to not go forward. I have lost a little weight and continue to do so but yeah, I understand the risks. Totally understandable. Love your informational videos, you have helped me to make this decision. 🥰 I’m 63..btw..scary stuff.
Hi This n That. Slow and steady wins the race. Best of luck to you in May. You’ve got this. Thanks for watching and subscribing
You have educated me throughout my research on Knee OA. Now, with honesty and kindness, you have given me hope!
Yay Michele! Good luck to you. Thanks for watching and subscribing if you did
I will definitely say my BTKR recovery was extremely hard (harder than most per Google TRR groups) and I had severe pain for much longer than my doctor allowed me to have pain meds. I lost over 100 pounds before surgery, but I'm still over 100 pounds overweight. I'd definitely recommend loosing as much as you can before surgery. I feel like I was prepared for everything else, but not this. I'm 4 mo PO.
Had my hip replaced on January 27th by a fantastic and talented surgeon. My hip was so bad that the ball was flat and my joint was eroding and migrating upward through the pelvis. There was no way I could have lost weight in that condition. A month out, I am rocking this titanium cobalt alloy and have lost 17 lbs. I’m thankful my surgeon believed in me as much as I believed in him. Case by case, gentlemen. You change lives. 🙏🏻
ETA: Surgery was an hour, no complications. I went home the same day: 10 hours from registration to release. Went in measuring 5’2”, and now that I can stand up straight again, I’m back to 5’6” (which changes my BMI, as well).
Hi OwnedByAGrey. What a great story. Thanks for sharing. Definitely every case is different. Congratulations on the weight loss and enjoy the new hip! Sounds like you and your surgeon made a great team. Thanks for watching and for subscribing if you did.
OwnedByAGrey my. Hip is just like yours but my surgeon won’t do surgery until the weight is gone. My BMI is 42 and I am losing weight on Nutrisystem. I am basically bed bound at this point.
Who did your surgery and where was. It done?
Carla Humphreys I’m so sorry that you’re in so much pain. I know it takes over every aspect of your life. My surgery was done by Dr. Eric Slotkin in Pennsylvania, and I was able to have it done at a surgical facility instead of a hospital. I hope you are treated very soon so that you can get your life back on track. ❤️
Thank you..... Need knee replacement and I told my doctor I wasn't doing it until I lost some weight. My short term goal was 50 lb and I'm now at 70 lb. So I'm delaying surgery cuz I'm not in much pain and once I hit my 100 lb goal I will get knee replaced. I know my doctor's very proud of me.
That is so amazing Cheryl. Bravo!
Oh my. I’ve literally doubled from a normal size 12 to obese size 24 in less than 2 yrs since excruciating injury. So depressing. You two are so compassionate and trustworthy. Thank you.
Hi Susan. Sorry to hear you are having a tough time. The best advice we can give is try to lose the weight slowly. We often recommend 1 pound per week as a goal which often is attainable. And use practical strategies. Generally speaking try to eat less, eat more plants and exercise if you can. Good luck to you Susan.Thanks for watching and subscribing if you did.
Love your honest and diplomatic discussion.
We do our best Orangeshebert. Weight loss is difficult for sure. We encourage our patients to do their best. Thanks for watching, subscribing and sharing with someone if you did.
I'm 5'10 , was 200lbs before knee surgery, Primary care Dr said I should lose weight. Now, 3 weeks after TKR I'm 180 lbs. online bmi caculator said 25.8 BMI. I hope to lose more once I'm back on my bicycle. My knee Drs are amazed at my recovery. My friend is looking at knee replacement, His doctor said he wouldn't do it until he loses weight.
Wow that is amazing! Congrats. Thanks for watching and subscribing
You guys give the best advice...I've been doing mostly plant based since I saw you in December Dr. Weening, and hopefully I've lost at least a little by my appointment in March. Doing my best.
Hi jeswainston. Glad to hear it! We can all only do our best. Keep up the good work and see you this month! Thanks for watching and subscribing if you did.
Thanks for this doctors (and for your other hip videos they have been very helpful). Hopefully it will help someone else to not wait as long as I've had to before they get relief. At least get a second opinion before you live in pain for months or years!
My hips are so bad they are in the process of autofusing and I have lost almost 2 inches because the joints have both collapsed. My left femur head is now necrotic. The X-rays are worthy of a case study! I have barely been able to walk for 8 months and have been in constant pain that whole time. My (now prior) orthopedic surgeon told me to lose 100 pounds. I did, which is pretty tough when you can't really exercise; my BMI dropped from ~50 to 38.8 and then he said he wouldn't do the surgery anyway, and did not even offer a referral.
Fortunately, I made many calls and I got an appointment at the Mayo Clinic. The surgeon there made sure I don't smoke or drink, discussed the potential risks of added weight, then said "rules are made to be broken sometimes and this is one of those times." I am scheduled to have the left hip replaced in 4 weeks, the right one 4-6 weeks after that.
Your best video yet, concise, supportive, realistic expectations. Well done. Here in Maryland, my brother's BMI was 37, and our Orthopedic Surgeon was on the fence pre op! BMI is taken seriously. Rightly so.
Hi Denise. Thanks so much. We felt strongly that this was an important but sensitive topic to discuss. Glad it hit the mark. Thanks for watching.
You guys have great content. Very helpful, I really like how you present and how you really consider what questions people would have. Thanks.
Hi Kate D. You are very welcome and thanks so much for the kind words. A lot of times patients have the same questions so it helps to think like that. Thanks for watching and subscribing if you did.
Great Video!
I am 6’2”. I had a knee replacement in preparation for retirement to repair a prior injury. After the surgery I went from 220+ lbs to 173 lbs and I like to maintain below 180 lbs. I used Keto and moderate exercise. I could not be happier!
Thank you for this video!
Stay safe and healthy!
Hi Ted. Thanks so much and congrats on the near 50 lb weight loss! You must feel amazing. It is interesting how insidiously the weight can creep on over the years. Many don't realize that even if you only have an extra 20 calories per day, every day (which is like 3 M and M's) that leads to 2lb weight gain and in 25 years is 50lb! Thanks for sharing and we wish you continued success. Thanks for watching and subscribing if you did.
You doctors are amazing. Before my double hip replacement I watched all your videos and boy, was I prepared! I was told I was "not very overweight" at 5'2' and 170 lbs. at 63 years old. All went great.
Hi Mrs Chester. Thanks so much! Glad to hear we helped get you ready and that you are doing well. Thanks for watching and for subscribing if you did.
I’m 82 and have an infection , I think😱. Hope not😔☹️😣😫😢😢
I’ve been obese most of my life. The first surgeon I saw said go home and lose 30 pounds and I can do the surgery. I tried and tried but was having very little success with the weight loss. I was in tears everyday from the pain. I went to another doctor and he said he would do it. Everyday I wake up and say a prayer of thanks that this surgeon was able to relieve my pain. In April I get one knee done, which I know will not be as easy as the hip. So this old lady at 70 years old weighing close to 300lbs is glad for the surgeons out their willing to do surgery on us.
There's no way you couldn't loose weight if you really wanted to!
Hi Mercedes. Thanks for sharing your story and so glad to hear that you are doing well. Thanks for watching our channel and for subscribing if you did.
Hi farsensor. So there are many people who struggle to lose the weight. It is not about wanting to - everyone wants to lose the weight. It is about many things. Thanks for watching our channel and for subscribing if you did.
Thank you for letting folks know that the desire is there. Weight has always been my challenge in life. I’ve heard it all my life “if you really want to lose weight.” That’s why I didn’t bother responding to that person. Many blessings docs. I love your channel. I always look for docs that have a good sense of humor. It makes the journey a little easier.
beltalowda some people have very slow metabolism and have a harder time losing weight....and most people that are overweight actually really want to lose weight
Very profesional and accessible material, thank you.
I regret very much that my grandmother was refused hip replacement due to her weight altough it was not any extreme. She almost does not walk . At this moment she hardly walks to the toilet, pushing a cart. Your video was very interesting to me, and I hope it will help some people do an effort try. Thanks again.
Very welcome SchattendragonflyPL. We always tell our patients they should try their best to get to a healthy weight but it is often not possible. It is very hard to lose. Best of luck to your grandmother. Thanks for watching, subscribing and sharing with someone if you did.
Great subject! This comes up often on the support groups I read. I changed what I eat, and lost 25+ lbs over 2 yrs, even with painful, crunchy knees limiting my activity. TKR in 5 days! I’m confident that if I keep eating lean protein, veggies and fruit, I will lose much more once I am able to join my husband on walks and hikes!
Good luck on your surgery! Just a few days away now!
Hi Alise and laura. Thanks for sharing your stories. Congrats on the weight loss. Keep at it. Eat sensibly - generally less food and more plants. Good luck with your surgery. Thanks for watching and subscribing if you did.
I've been rejected by two surgeons for a THR. I'm 5'9, BMI is 40. They both told me to lose 40lbs, then they will do the surgery. It's really hard for me. My mobility is very limited due to the excruciating pain. I'm often sitting or lying around because any movement hurts so much. I've quit smoking over 6 mnths ago, I'm stressed and depressed. I'm also perimenopausal and my cravings for sweets and carbs are through the roof!! I feel defeated 😞 Mind u, I had back surgery in August of 2022 at the same weight. I didn't have any complications and I recovered just fine...
I’ve come across your channel by accident and so glad I did. I had spinal infections 15 years ago and spent 3 months in hospital, another 8 hour spinal op due to bugs undoing my metal and 6 years on oral antibiotics. I was supposed to have 2 knee replacements 4 years ago but cancelled due to the ‘Fellow’ at the hospital at my pre op telling me if my knee replacements got infected it would have to be amputated…..that’s the only word I could 👂 hear after him talking to me and decided I couldn’t go through with it. I didn’t realise 4 years on that they would become so bad that I’d be in terrible pain especially at night and the pain would refer into my ankle, also my mobility has become so bad I cannot walk outside at all nor drive so am virtually housebound now. I’ve been extremely depressed this year due to my ‘different’ life and have also put on weight. I cannot live my life like this so am back on the list for knee replacement, I have just had a pre op and it was impressed on me and I’ve had to sign to say I understand that I have a 1 in 5 chance of my new knee or back becoming infected, amputation , having a heart attack or stroke! I’ve put myself on a very strict diet and in two weeks between the 2 pre ops (had to have an cardio gram and see anaesthetist) lost 3kgs and 2 BMI points now 42 and will continue to diet plus suggested i have op in February so I don’t have to have another pre op but hopefully would of lost another stone but was told no as my x rays say it needs to be done urgently now. You guys have put my mind at rest quite a bit so thank you as I am so worried about the whole procedure. I have 1 question both legs are terrible and can’t walk on them, how long do you normally do the second knee op after the first if the patients knee is so bad the first won’t support them after surgery?
Hi Jo. Best of luck. Glad we could help in any small way. We usually do the second one about 3 months later. Take care. Thanks for watching and subscribing if you did
Any surgery has risks I have osteoarthritis in both hips and can't walk or exercise so what you just sit here and get worst especially when you have to use a walker full time and can't cook or exercise typical western doctor advice losing weight is like anything else you have to want too and know how brilliant advice.
Hi Tony. That’s why we advise lose what you can and don’t make people wait jusr because of their BMI. Best of luck. Thanks for watching and subscribing
@Talking With Docs well that's what I was told the pain is unbearable I know how to lose weight but this is what happens when HMOS dictate to doctors because of money and law suits .unconditionally will continue to get worse I know it and they know it.
I'm in my 30's and overweight. I had 7 doctors who told me to just get cortisone shots till I'm old enough for a replacement when I'm 60. I think they were dismissive because of my age and weight. I had a BMI of 35 for several years. But as my knee pain got worse, i started to gain weight. BMI went up to 39 in under a year because I couldn't be as active. Finally found a doctor who really looked things over and took measurements. My knees were misaligned causing arthritis to progress faster. I've now had partial replacement and realignment. Still in the first few weeks of surgery on the second knee, but the first feels amazing. I am looking at this as my kickstart to getting healthier. Last year I couldn't even mow my flat yard that takes 40 minutes. My goal for about a year from now is to travel to Australia and hike the highest mountain there. Why? Because I'll be able to. I feel like I've been given my lufe back.
Thank you so much for addressing this issue. It has been common practice in the USA to flatly refuse knee replacement surgery to anyone over 50 BMI. So it is very wonderful to have you suggest a plan that will work for those over 50 BMI. I also appreciate the Canadian input as it always seems to be more compassionate than ours here in the USA. Thank you so much.
Very welcome Colleen. It is a tricky issue for sure. There have been some recent papers that have shown that performing bariatric surgery for weight loss before total joint replacement is a successful option if considered. Thanks for watching and subscribing
Ok…here is my proposed hip equipment. Cup = Depuy Dual Mobility. Stem = Depuy Trilock/Actis. My BMI is 24.3. I’m 77 years old. My surgeon has performed approximately 4,000 hip replacements.
Hi Jim. Sounds like a solid plan. Does your surgeon get a say? Good luck. Thanks for watching and subscribing if you did
I love your videos, thank you.
Glad you like them!
I was worried about this too, but my surgeon never said I was too big (at 5 feet even and 178 lbs - BMI was about 33).. I was just wondering if I was too big. I planned to try and lose weight, but didn’t start until about six weeks before surgery and got down to 166, by just cutting out the junk. It was difficult to lose weight through increased activity as it was uncomfortable just walking around. But once I’m able to get around better, I figure I owe it to my surgeon (and myself) to show I can do better at losing weight. I WANT to be more active. Love talking walks through parks and riding my bicycle. I hoped he didn’t have too hard a time getting through my hip flab. Maybe having me on my side made it a little easier due to gravity. Losing weight might also help delay needing the OTHER hip replaced. I definitely plan to be progressively thinner as I make it to my follow up appointments, proving that my increased mobility has allowed me to get regular exercise.
Guys, I love these vids! I'm an advanced practice physiotherapist working in the uk. I spend most my time intercepting GP referrals to sort the appropriate orthopaedic patients from the ones who need more physio.
Unfortunately often patients trust their GP more than us specialist MSK physios because they are a doctor, so when I ask them to trial some conservative options before surgery, they say we'll my GP said I need surgery!
So it's nice to be able to point them to these videos which re-enforce in a clear way what might be wrong, how we know and what investigations are and are not appropriate and what treatment options they should try, and it comes from a doctor. (though I wish they trusted my opinion in the first place).
Hi Rob. Thanks for the positive feedback and for sending your patients to our channel. We lean heavily on our physios here. Often patients will ask for a list of exercises and we say "you need to see a physio because they are the experts". Stay safe in the UK! Thanks for watching and subscribing if you did.
so true, it's challenging to lose weight for me due to arthritis in BOTH knees, Dr is talking about joint replacement, it's literally bone on bone...BUT I live up on 3rd floor....I walk up and down the stairs, is it easy? NO def not BUT in doing so and moving more, changing eating habits, I've lost over 80# and with the help of cortisone shots to the knees...the pain is now gone...dr said once it wears off joint replacement...that was 3 YEARS ago..still going...lost another 15 pounds in 3 months...slow yes but at least I didn't gain the weight...it also has helped my asthma, I'm able to go up and down the stairs without dang near passing out..literally...I love your manners, and wish you were my dr's..... please stay safe Doc's
Hi IAMdevilwomen. Congratulations!! And thanks so much for sharing your story. You have a great approach. Slow and steady will get the job done but it does take discipline and will power. We wish you nothing but the best going forward and are so glad we can help in any small way. Thanks for your kind words. Thanks for watching and subscribing if you did.
Thanks!
Welcome! Thank you so much for your support
My hubby had L TKR 3/31/2011. He was 5'11" and weighed 375 pounds at the time of surgery. He got a Stryker knee. He was 0 weight bearing for 6 weeks to allow surgical cement to set. Because a old pin had to be resectioned to prepare the tibia for the artificial joint. He returned to work in 12 weeks as a tool repair tech. With lots of standing and lifting involved.
On 11/08/2013 he fell and severally Injured his healthy R knee. Requiring two seperate surgeries within 8 months in 2014. With a third scope scheduled for 3/24/2020. Possible R TKR to follow in the near future.
It will soon be 9 years since L TKR. He has lost 50 pounds and counting since the L TKR. While the injury to his R knee has left him unable to work. He has had zero problems with his current L TKR. We credit the success of his L knee to a highly experienced surgeon and a really good artificial joint manufactured by Styker.
Hi Sarah. That is a great story. Good work by your husband to put in all of the hard work required to lose 50lb. Hope he continues to do well particularly with his upcoming surgery. All the best. Thanks for watching and subscribing if you did.
@@TalkingWithDocs I subscribed and hit the bell. Thank you and God's blessings as you help others in need. I'm really glad your video popped up in my watch list.
Hi Docs! I was so happy to see this. I am not sure if you all address any questions here so I hope this isn't inappropriate but, if I may... I have a wonderful man in my life who has suffered for so long. He is 60 yrs old and has needed hip replacement for years now. His BMI is around 50 (a little under 50) he saw 2 surgeons here (in VA) who do want him to lose some weight first. He has gone down a bit with no substantial loss of weight. His mobility is down to what we might call *impossible* . He can walk *only* with a walker, he is in a great deal of pain, his movement is limited to a *little* slow and labored walking around the house, he can barely get in and out of a car now (because of the hip, these things are not weight related). From the time he was first diagnosed and was told he needed surgery, he is a different man. His condition is just terrible. I do worry about him having higher risk surgery but he has gotten so bad now that he honestly cannot move enough to lose large amounts of weight. How would you recommend he approach this with his surgeon (or another surgeon). If you were his Dr., you would do the surgery? Any advice you have would be greatly appreciated.
Hi Megan. Thanks for sharing your story and we are sorry to hear he is having difficulty. It is difficult to lose weight - otherwise everyone would do it! Best approach is to get some help - weight watchers or some other program. Focus on eating whole foods and certainly more plants. If somehow he can get rid of animal products he has a much higher chance of losing the weight. With respect to the surgery, I think being honest and explaining he has tried as hard as he could and ask for the surgery. There is not much else you can do other than continuing to see other surgeons until you find someone that will do it. The one thing to be aware of is that once patients get their joints replaced, they often do not lose any weight. It is a multi-faceted problem that requires assistance - either your GP or a nutritionist or both. Good luck to you and thanks so much for watching.
@@TalkingWithDocs Thank you so much for getting back to me! I eat a plant based diet myself so I talk to him a lot about this and he has actually made some huge steps. He has given up _red_ meat and eats a lot better in his attempt to lose the weight. I will keep encouraging him to move to a more plant based diet. Regarding the surgeon, I think we will absolutely talk about him revisiting this with his surgeon as well as seeing others. It's good to know that you feel - even with his weight issues - that we should see if we can find a surgeon who feels comfortable doing it. We'll do that as well. Thanks again!
I am 5 ft 8 and 230 lbs my weight is around my chest and tummy. My hips and legs are not big as I used to work out every day and it made me strong. I have ranged in weight in my life from 120 lbs to 300 pounds. And I spend my life in restriction. And once I lose weight it creeps back. My surgeon has not expressed concern I did he said he's handled people bigger than me. I hope I don't die on the table with a bmi of 36. Very nervous.
Hi G G. We often operate on people with BMI greater than 36. Good for you for working so hard and all the best with your procedure. Thanks for watching, subscribing and sharing with someone if you did.
It’s painful for me to exercise (I’m 52) former Firefighter/EMT, former ER Tech so a lot of time on my feet…however my BMI is 40 so this was helpful to me so I can set a goal with low impact exercise…because as you know eventually Synovia will maybe stop working and then I will either need a partial or full depending what they find…thank you!
Very welcome Susan. Best of luck to you. Thanks for watching, subscribing and sharing with someone if you did.
Thank you for the always great information (and humor)!
As of yesterday I have 2 weeks left before my left knee replacement.
My goal/momentum is to lose at least 5 pounds by then, and then keep going down until I lose 45 more in a healthy and sensible way.
More than anything I look forward to being able to do low impact exercises with no pain once I’ve recuperated. 🌹
Best of luck to you Jackie! Hopefully we have helped you get prepared. Thanks for watching and subscribing
I am slowly working on diet and lowering my A1C before getting a revision done! Thanks for information! I have lost more weight thank you but am still waiting for dental work which keeps getting delayed. Hopefully soon. Thanks again for all your videos and waiting more. God Bless.
Hi Darlene. You are very welcome. Slow and steady wins the race. Probably more plants. Best of luck. Thanks for watching.
@@TalkingWithDocs That is what I have been trying to do, more plants, Thanks Docs
These seem like 2 great doctors and I'm sure they do great work. But my plan is to lose enough weight that I will never need to see them. God bless!!
Hi Ann S. Challenge accepted! Good luck to you and thanks for watching.
Very helpful Dr’s ,thank you very much
Very welcome Richard
I lost 78 pounds this year in order to have this procedure. Had my left TKR on Tuesday. I cannot imagine doing the rehab and just getting around with that much more weight.
Congrats Kimberley! That is amazing. Way to go. Thanks for watching and subscribing if you did.
I adore you guys!!! I live in the US & have had a myriad of health issues over my 50 years but most always they go back to my own underlying struggle with eating too much of the wrong foods. I'm actually very well educated in what to do to lose weight. I often do well & then I get in my own way. I'm currently on my way down from 358 to 285 & I have a Boston doctor who has agreed to do my knee replacement surgery. I've had 14 surgeries in my life & I go under light anesthesia for usually 3 Ablations via "Coolief" as I live in Chronic knee & back pain & thank God I never have problems with anesthesia. So my question would be "Do you have any advice for me?
Hi Sci-Fy Hero. Thanks for your kind words. Congrats on the weight loss! Our best advice is to lose as much as you can. work on your range and strength before surgery and after surgery - work like crazy. Hope that helps. Thanks for watching and subscribing if you did.
Love your attitudes Brad and Paul. Especially your motto, we are in-charge of ourselves. The number of times I saw my parents not have a clue as to the medications they were being given in hospital after surgery, let alone what it was for. Patients don't realise that while there are staff safety measures in place to ensure medications are correct, mistakes do happen.
So when I am asked my name and DOB, I will ask what I am being given and when possible with tablets, I will want to see them, that they are what they are meant to be. Too many patients take no responsibility for their care.
Hi Lyn. Thanks so much. Yes it is important for patients to be engaged in the process. Thanks for sharing and for watching
Hi and thank you. I worked with doctors in surgery and learned that if a obesity patient will lose 25 lbs before surgery they will have a much better outcome. But nutrition must be correct, no fasting or otc pills. I had my hip replaced at 57 BMI but I loss the required weight. Everyone felt better and my surgery went fine with excellent results. That was in 2003 and I still have the original repair. Doctors have you ever heard about the weight loss effect? 🙄🤔
Hi Juli. Way to go on the weight loss and so glad to hear you are doing well 17 years later. We have not specifically heard about the weight loss effect. Thanks for watching our channel and for subscribing if you did.
Thanks. Very helpful.
Glad it was helpful!
Your videos are great, and contribute to the average Joe's medical knowledge. A great service to humanity - you need a wider audience! By the way, you should start a merchandise store, selling, at the very least, those colorful hats you wear during videos. LOL
That is awesome Chad. Thanks for watching and subscribing
Can you guys please do a video on hip revision
I have had both hips replaced 2006 at 41 years old 2 months apart last year started having a lot of pain so now they want to replace both again metal on metal
No plastic
No now say Titanium was really not very good
Wear and tear of the two metals getting in my blood Stream
And my surgeon says the doctor that put them in had drilled my Hip sockets wrong and they would need to redrill as the sockets are sitting off to one side
I was hoping that by now the carbon fiber hip replacement that the U.K. does would be in America by now
So hopefully you can do a video on hip revisions
I'm now 55 yrs old
Also have the new bone growing over my hip replacements that's been cut out twice now and keeps growing back giving my very limited side to side movement
I was one of the first patients to receive the robotic assist machine to Make keep everything in my legs straight but with the sockets being drilled wrong I don't think that work out to good
Hope you can help
Learned a lot from you to doctors
Great videos
Thanks
Michael
Hi Michael. So it is difficult to address specific questions without examining you and your imaging. We have a video on metal on metal total hip replacements and many have had to be revised not only because of the ions in your bloodstream but also because it can lead to an inflammatory reaction in your muscles. The best option for revision is a metal on plastic bearing surface. Some surgeons will use a ceramic on plastic bearing surface. Hope that helps clarify and yes we will consider doing another video on hip revisions but be sure to check out our other videos. Thanks for watching and subscribing if you did.
I gained about 8# because my hip hurt and couldn't walk like I use to...going to get back in shape soon as the hip heals. ..great video!!
Nice Robin. Good luck! Thanks for watching, subscribing and sharing with someone if you did.
BMI was 42, doctor wanted it below 40 to consent to surgery, I'm below 35 and heading to 30.
I had an American friend online go in for a full hip replacement. She was in her fifties with a BMI that was high.
She contacted me in fear and great pain and could get no help from her health care team. She was alone with no help and couldnt ģet out of bed. Four months later they found her passed in bed.
Oh no Kate that is horrible. We are so sorry to hear this
MY BMI was over 50. My knee joint pain got to the point that I litterally could only walk about a 100 feet with two canes. At this time i lost more muscle and gained weight. I have had each knee done 6 months apart and am doing well.
Hi Sandy B and unionjackess. Thanks for sharing your story Sandy and we are so glad that you have done well. Keep working hard to use your knee replacements for positive life change. Good luck. Thanks for watching and subscribing if you did.
This is great advice- listen up folks.
Thanks so much CJC. Thanks for watching and subscribing if you did.
Have you guys done a video on Neck Surgery, and when is it safe to drive a car after surgery?
No. It's on our list for sure. Usually you can
Good presentation
Hi Kathryn. Glad you liked it! Thanks for watching and for subscribing if you did.
Thank you for such an informative video. I realize my obesity makes everything more serious and risky; however, you two mentioned things I had no idea about! (For example, I had NO idea that our excess "tissue" can even increase our risk of infection !!!! ) I'm very glad I watched this, and I like the way you two explain things----but now I'm even
MORE terrified to have surgery! LOL!!!!
Ha Adora. Yes it can be daunting. Best of luck! Thanks for watching and subscribing if you did
When a patient falls into the category where as they lose mobility and pain increases and they gain weight, it is ridiculous for the doctor to tell the patient to lose weight until the patient ends up in a wheelchair while not losing weight. At 61, formerly athletic with a BMI of 41, with no diabetes, no high cholesterol, no heart condition (total CT Calcium Score of 16, Left anterior descending 13), no resting high blood pressure, where the bone on hip is a 10 out of 10 bad, No drugs, alcohol, smoking or asthma. In my opinion it is medical malpractice to deny total hip replacement. Hips are not knees, the ball sits in the hip pocket. Compound the issue by using the BMI height an inch less than adult height (on govt security documents) (9 pound BMI difference) where neck injury gives the patient a hunch, BMI is a set of numbers that doesn't take into account the frame size of the body. Primadona doctors who tell almost cripples to lose weight should have their licenses pulled and made provisional for the prison population with a respective hefty pay cut.
So yes BMI is probably better replaced by waist hip ratio. Pain does limit the ability to exercise. Quite frankly we don’t tell anyone no. We do encourage weight loss as regardless of one’s current health carrying extra weight is associated with a host of medical issues. As well more and more centres have shown the benefit of bariatric surgery before total joint replacement. The risks of joint replacement are very real and are increases as weight increases. It is certainly a complex and multi factorial issue. Hope you get your surgery
@@TalkingWithDocs Docs weight by itself is not a significant factor in negative outcomes, whether it be covid or surgery. There are actual covid studies where obesity was associated with a greater percentage of positive outcomes in certain age brackets. With respect to bariatric surgery, there are more percentage of negative outcomes of bariatric surgery than total hip replacement. If a 61 year old has a 41 BMI and has no high blood pressure, no diabetes, no high cholesterol (people die of low cholesterol, high cholesterol people don't die of cholesterol which your body makes, they die of plaque that can be seen with scans), a CT calcium score of 16, what are these "host of medical issues". Someone recently in media on obesity said obese people don't live to be 90. Don Rickels and BB King both obese, both reached 90.
Thank you for this informative video. At 58, my right knee has been replaced 2 times totally, with a revision in between over 5 yrs. my left knee needs it now. My BMI is 44 and my dr won’t do it until it’s less than 40. He wants me to have Bariatric surgery to get it off quickly. The plastic meniscus broke twice in the replaced one and he feels its weight related. Do you believe this could be true? Thanks again!
Hi Sandi. It is difficult to answer your question without a proper examination and review of your imaging. The plastic liner in total knee replacements are the most common area for failure especially in the setting of an elevated BMI. So it could be true. We have had patients who have chosen bariatric surgery to lose weight before surgery. This is a very personal choice and a very big decision. The best way to think about it is that it is a way to prolong your life rather than the life of your knee replacement. Bariatric surgery requires a lot of planning and discussion to make sure it is appropriate for you. Best of luck to you going forward regardless of whether you choose bariatric surgery or not. Thanks for watching and subscribing if you did.
Talking With Docs thank you for your insight and kind opinion. I am very grateful for your response and will consider everything you have said. In particular your comment regarding extending my life. I have subscribed and I look forward to more informative videos.
What about insurance coverage? Is there a maximum BMI for a total knee replacement? Thanks!
Hi Theresa. So in Canada there is not a specific maximum BMI but as it increases so does the risk so it can get to the point where the risk is too great. Thanks for watching and subscribing if you did
superb and honest
Hi Anamika. Doing our best to do both. Thanks for watching, subscribing and sharing with someone if you did.
I had an epidural for my bilateral knee replacement to limit risks of anesthesia. You guys are great. Yes, I did subscribe.
Thanks so much judith. Glad the epidural worked out for you.
Had rt hip replacement several years ago, fortunately lost some weight just before. Since, my physical exercise has increased, I have lost a few pounds, but more importantly have increased muscle mass, much stronger. I assume my bmi is the same, although I am much healthier.
Hi Tink. Yes it is not about a number. It's about eating healthy, exercising and doing your best. Congrats. Thanks for watching
Thank you for this video! I am going for hip replacement and I am on Ozempic to lose some weight before I go in around November. I have watched all your videos and will show my appreciation!
You got this!
Definitely needed to see this because I’m thinking about hip surgery but concerned about my weight….BMI is 33 for my height
Hi Sonestia. We encourage all of our patients to get strong before surgery and if they can lose weight it often will make recovery easier. Hard to do though for sure. Thanks for watching and subscribing if you did
What is your opinion of the MISHA Knee System
It's been 8 weeks since full knee replacement surgery, Why my knee feels heavy after surgery?
Good information guys!
Hi Lynda. So glad we could be of assistance. Thanks for watching.
What is the name of the hospital where you perform your joint replacements and in what city, state are you located?
Hi Maybeth. We are in Ontario, Canada. Where are you? Thanks for watching, subscribing and sharing if you did.
Where do I find a Doctor in South Carolina that will do Hip Replacement with a 45 BMI ? I just had gastric sleeve and am losing weight but I need a hip replacement ASAP.
Hi Craig. Typically we would not turn someone away with a BMI of 45. It is in your best interests to lose weight but not a contraindication. Best advice would be to call around. Good luck. Thanks for watching and subscribing if you did.
When evaluating a patient for tkr do you take into consideration recent surgeries? I recently had a sleeve gastrectomy so I would think that should prove I have no problems being anesthetized. Before the surgery my bmi was above 70, now I'm close to 50, but weight loss as slowed. It's just so hard to lose weight when it's difficult to exercise.
Yes for sure everything is taken into account. Congrats on the loss this far and best of luck going forward. Thanks for watching and subscribing
How do I get in contact with you about hip replacement ? My BMI is 41% and my hip is horrible shape...I'm in South Carolina and several Doctors have said they can't help me until I get below a 40... I can't hardly walk...I need to have something done. It's severe pain. Would love to have a conversation with you.
Hi Craig. Sorry to hear you are having a difficult time. Unfortunately we are in Ontario Canada and can’t see patients from out of province. If you keep searching we would suspect you could find someone who would operate at your current BMI. We wish you nothing but the best of luck. Thanks for watching and subscribing if you did
Thanks for such a great video! Hey, have you ever done, am I too OLD to have this joint surgery? As a Geriatrician, I'd love to see your take on that!
Hi The Wrinkle. As a matter of fact we have. We did a video on whether or not patients were too young or too old. The take home message was that age is relative - as we are sure you see every day in your practice. We have replaced knees as young as 30 and as old as 95. Everyone is different so age is not an absolute contraindication. Thanks for the ongoing support!
@@TalkingWithDocs Wonderful! I'll check that out. I have some people in my practice in their 90s who would be fit for joint replacement for sure. Lots of golfers.
@@TalkingWithDocs I'm glad to hear that you don't focus on age. From the age of 55 I had two different rheumatologists tell me I needed a hip replacement but my family doctor wouldn't give me a referral to an orthopedic surgeon. Instead he gave me medication for the pain. I finally got mad and he gave me a referral and I had the surgery at 61 years old. It changed my life and I'm now more active and no longer walk like Quasimodo. Thanks for the informative videos!
OK, I understand that being overweight carries issues with it. However, if you have gained weight because of knee and back pain, then what are you supposed to do? I find this to be a catch-22. I had a job that carried a lot of risk. Many assaults and injuries. I just retired, but can't stand the pain in my right knee. I think that it will be hard decision on my part.
Hi Karen. Yes it is complicated. It is hard to lose weight with sore hips and knees. One issue is that patients do not typically lose weight after surgery. We do not prevent people who carry extra weight from having surgery. Best of luck with our journey. Thanks for watching, subscribing and sharing with someone if you did.
@@TalkingWithDocs Thank you for the reply. I am beginning to think the pain is referred from my lumbar region, which has moderate degeneration. If I can get on the right pain medications then I can get busy again.
If a person gets skin boils occasionally , would that prevent them from getting a hip replacement?
Not necessarily Murphy but you would want to keep an eye on the skin. Thanks for watching and subscribing if you did
I have a very high BMI 57 so surgeon denied my HIP replacement operation. So I live on NSAID Mobic to get me through the flair up, imflammation, pain. I wish I could lose this weight. My doctor told me to consider weight loss surgery,
Hi Edgar. Sorry to hear that. It can be complicated. Bariatric surgery does work for many. The other option is a whole food plant based diet. Best of luck. Thanks for watching and subscribing
@@TalkingWithDocs Thanks. Doc referred me to a nutritionist so I'm going to try that first. Also interested in Intermittent Fasting. If all fails then I will consider the weight loss surgery program. Left Hip is really bad and right HIP is not so good either but more manageable. For the future is it better to have surgery on both HIPS at the same time or one at a time?
@@TalkingWithDocs I don't understand, they don't want to give anesthesia over 50BMI, Risk of infection ect but ok to operate for bariatric surgery?
After i completed my 6weeks from ankle surgery january 0f 2023 i was told 110kg was too high for my height
I was told BMI has to be 40 or below for hip surgery.
Really depends on the surgeon. That does help reduce the risk. Thanks for watching and subscribing
My bmi is 40, and 2 surgeons rejected me
how can you say surgery is harder for the surgeon, how can help if your weight lost is in different area's and nothing on your knee's, then what would one do...
Hi Granny. That is simply the truth. We still operate on a lot of patients that carry extra weight all over their bodies. We are simply trying to tell patients to do their best to lose what they can. It is very hard though. Hope that helps. Thanks for watching, subscribing and sharing with someone if you did.
I am 43 and have a family history of osteoarthritis and I weigh 324. I also had a work injury (complete torn meniscus) and now, I can barely walk a city block without needing to sit from the pain. Am I a candidate? My doctor said I’m too young and I need to loose weight. It’s hard to exercise when I’m in constant pain and pain meds doesn’t really work.
Hi Lisa. Sorry to hear you are having a tough time. So if you have advanced arthritis you are a candidate. The main issue is that you have a much higher chance of requiring a revision because of your age and your elevated BMI. It certainly is difficult to lose weight by exercising when you have sore knees. A much more successful and potentially more long term solution is to get some assistance with understanding healthy food choices and making good decisions on a daily basis. Weight loss is very difficult and most people cannot do it on their own. Our best advice is to get professional help from someone like Weight Watchers or other similar organizations. Not necessarily someone selling you specific food but teaching good eating habits and helping you stay accountable. Best of luck on your journey. Thanks for watching and subscribing if you did.
Talking With Docs thank you for responding. I actually made an appointment with my ortho doctor and he said that I am a candidate, I have since lost 10lbs. He said that I could have the surgery now but we both agreed for me to loose weight and revisit in December to see how much I lost, and if I'm down by 50lbs, I can schedule my tkr in January 😊
Great info
Glad it was helpful P Olesen. Thanks for watching and subscribing if you did.
My father has had a case of knee arthritis since years and it's gotten way worse now. He refuses to lose weight and the pain is affecting him greatly now. How can I make him realize the importance of losing weight. He hasn't made any changes in his diet or lifestyle even though the doctor has given him an ultimatum of either lose weight or lose your mobility. :(
Hi Shivangi. It is very complicated. If weight loss was easy everyone would do it. Just be positive and encouraging. All the best. Thanks for watching, subscribing and sharing if you did.
Hi, I'm 50 and 2 years ago I was diagnosed with A Vascular Necrosis. I use a walker and almost ready for a wheel chair. I use to be very active. I was losing weight and feeling great before this. I can barely walk anymore but I push myself and bite through the pain because I dont want to be in a wheelchair. Ive gained so much weight , I am trapped in my own body. I saw an Orthopedic Surgeon and was told id have to lose 130lbs before he'd touch me. I live in Michigan and wonder if you know of any surgeon that would put my weight aside and give me my hip replacement so I can have my life back.
Hi Missy. So sorry to hear this. With AVN it will be very hard to be active and lose weight. Best advice is to call around different surgeons to see if they would take you on as a patient. Best of luck to you. Thanks for watching and subscribing if you did
Hi docs, is it risky to have a hip replacement surgery if your too heavy?
Hi Alida. There is evidence that the risk of complications is higher if you have an elevated BMI. Thanks for watching and subscribing
Asked replacemen
my father is 92 years old he got hip dislocation. Can he be treated for hip relocation without surgery.
Yes but it may come out again. Usually first treatment is closed reduction. Good luck. Thanks for watching and subscribing if you did
THERE IS CHALLENGE WHERE I HAVE NOT LOST WEIGHT , YET I EXERCISE WALKING 7 MILES / DAY . (THIS MAY HELP IN TERMS OF ENDURANCE & FLEXIBILITY) .
Hi Paul. Then the next option is to reassess the types and amount of food that you consume. Best of luck
yes really wish I had lost way more weight before my surgery knee surgery I think this would have made walking much easier.
Hi House scrapper. Well it may have. Just work hard and lose it now! Good luck. Thanks for watching and subscribing if you did.
At 89 I am considered too old for knee replacement by my HMO! I can see some rational for this but as a generalization it strikes me as flawed. Weight would not be an issue, but the fact that I have type II diabetes--is this an issue?
Hi davy91101. Diabetes is an issue but not a contraindication. Neither is age for us. We have replaced joints as old as 95. We have a video about this topic. And weight is also a relative issue. Keep pushing and hopefully they will let you get it if that is what you want and need. Thanks for watching.
I'm in rehab and people literally can't bear weight after surgery without dislocating or even fracturing their own bones when they are obese.
I got my BMI down, now they are arguing sorry discussing my low ejection rate.
Good day, please how much will it cost me to correct my slight bowlegs with external fixator in HSS? I'm from Nigeria
Hi victoria. You would have to talk to the surgeons at HSS. Good luck. Thanks for watching and subscribing if you did
@@TalkingWithDocs I don't know how to that was why I sent the message here. I tot you are a surgeon at HSS
These are ortho surgeons, right?
I was wondering about that. What about people who always were "hippy" even when they were younger, weighted much less and not the 33.9 BMI i have now. Ohy!
It’s all good M. Thanks for watching and subscribing
So I have osteogenesis imperfecta and osteoporosis over a hundred fractures to date and use a walker due to sciatic nerve damage and falling is bad. Zero metabolism from being forced to do intermittent fasting and one meal day all throughout my childhood. I’m obese and I eat healthy meal. Don’t snack. Don’t drink sugary drinks only water and one cup of coffee a day with no sugar or sweeteners. How the hell do I loose weight?
Hi Sunny. Sorry to hear about your struggles. It is hard for everyone to lose weight. One option to consider would be an entirely plant based diet. One of the problems with animal products is the density of calories. Small volumes of food have a lot of calories and do not fill your stomach so you are tricked to think you need to keep eating. That is why add whole foods with lots of fiber fill you up more. Best advice is to seek some professional help to get you on the right path. Best of luck. Thanks for watching, subscribing and sharing with someone if you did.
@@TalkingWithDocs yeah thanks so much but Plant based is an extremely unhealthy option as it’s nothing but high carbs and sugars. I’ve thoroughly researched every diet you can imagine. I work closely with a nutritionist but the weight just doesn’t come off. It’s frustrating. Lol.
I had a hip replacement 11 years ago. From day 1 every time I bump against something, especially with my foot, I experience pain in my hip. I assumed this was just part of having a replacement. I was told that this is not normal and most likely the ball was ill fitted into the socket resulting in the ball bumping against the socket. Could this be a realistic explication for why I experience pain when my hip is jarred?
HI R Wilt. Sorry for the delay. So it may be related to loosening but best to get properly assessed with a physical examination and xray. Usually the bumping would not cause this pain. Good luck to you. Thanks for watching and for subscribing if you did.
BMI at time of hip replacement surgery = 30. Deep peroneal nerve injury. Very weak dorsiflexion in the foot of the surgical leg. Wish I had listened to my gut feeling that I was too fat for this surgery.
Hi Arkleston. Sorry to hear about your nerve injury. It can happen and likely is NOT related to your BMI which is mildly elevated. Many patients with much larger BMIs do well so don't blame it on that. The nerve injuries will often improve with time. Best of luck to you. Thanks for watching, subscribing and sharing if you did.
My orthopedic surgeon will not operate on patients over 35 BMI. The risks are too high, and he boasts a terrific recovery rate!
Hi Katharine. That is interesting. We would have to turn away at last 1/3 of our patients if that was the case. And yes, recovery rate would be better if you only operated on thin, healthy people. However, it is often older or heavier or people that do have some medical problems that need help. Every surgeon has a different philosophy when it comes to weight. Thanks for sharing. Thanks for watching our channel and for subscribing if you did.