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REVIEW ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 2  |  Page : 57-58

Knee replacement in obese patient


Department of Orthopedics, Apollo Hospital, New Delhi, India

Date of Web Publication5-Jul-2018

Correspondence Address:
Yash Gulati
Apollo Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_49_18

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  Abstract 

There is no doubt that conservative treatment is preferred by a patient and doctors for knee pain. However, if the patient develops severe arthritis with disabling pain, the only choice left is knee replacement. This applies to patient with average weight as well as obese. The author in this article has given his views on doing knee replacement in obese patient with severe disabling pain. The result of knee replacement in obese patient is very encouraging, and they should not be denied this surgery just because of their weight.

Keywords: Knee arthritis, knee replacement, obese patient


How to cite this article:
Gulati Y. Knee replacement in obese patient. Apollo Med 2018;15:57-8

How to cite this URL:
Gulati Y. Knee replacement in obese patient. Apollo Med [serial online] 2018 [cited 2018 Jul 23];15:57-8. Available from: http://www.apollomedicine.org/text.asp?2018/15/2/57/236003


  Introduction Top


Knee arthritis can be due to age-related degeneration of the joint or due to inflammatory arthritis such as rheumatoid arthritis and psoriatic arthropathy.

There may be a genetic predisposition to knee arthritis in some patients. Over weight per se may not lead to arthritis but can aggravate the degenerative process in a patient who is prone to develop it for other reasons. Furthermore, if arthritis does develop, obese patients are less likely to respond to nonoperative treatment.

It is therefore very important to keep one's weight check to prevent degenerative changes in the knee.

Weight reduction can help avoid or delay knee replacement surgery in most cases but up to a point.


  Knee Replacement-When? Top


If arthritis becomes advanced with severe changes in knee joint causing continuous pain and difficulty in walking, knee replacement surgery may be required.

It could be partial knee replacement or total knee replacement depending on the type and extent of involvement as seen on X-rays.

There is no question that if a patient is thin and average weight, surgery is easier to perform, postoperative rehabilitation is faster, and chances of complications are also less.


  Knee Replacement for Obese? Top


Hence, what do we do if an obese patient with body mass index (BMI) of over 35 kg/m 2 develops severe arthritis which would merit knee replacement?

Do we condemn an obese patient to pain or offer surgery?

Knee replacement in obese patients carries higher risk of infection, thrombosis, slower rehabilitation, and increased length of stay in hospital, and survival of the implants is relatively less.

However, research has shown that the difference is not so much as to deny knee replacement to grossly overweight or obese patient.

It would be very nice if one could lose weight by diet control or exercise before surgery. However, it is easier to say than to do, and chances of getting thinner by these means are very slim!

What about weight reduction by bariatric surgery?

Research has shown that patients develop anemia, malabsorption, osteoporosis, and other changes in physiology following of bariatric surgery.

It is controversial whether benefit of lower weight by bariatric surgery is enough counterbalance risks of complications due to altered metabolism.

However, if bariatric surgery is done, one must give a gap of at least 6 months before knee replacement is done to prevent complications.

Patient often says that, because of arthritis, they cannot lose weight as they cannot walk enough. Sometimes, they presume or they are promised that following knee replacement, they will lose weight due to increased mobility.

That is contrary to the findings in the research conducted at various centers.

There is no change in BMI after knee replacement compared to patients with arthritis who have not undergone surgery. In fact, there may be increase in weight 2 years following surgery, because patients have much better quality of life following pain relief and tend to eat even better! This must be keeping in mind and steps to be taken to avoid this tendency.

However, the good news is that overweight or obese patients have excellent pain relief following knee replacement in case it is required because of advanced arthritis.

Even though knee replacement in obese patients is challenging, technology has come to surgeon's aid. Availability of computer navigation such as gyroscope-based navigation system makes getting the alignment easier and reduces bleeding and rehabilitation is faster.

A little more restrained or constrained type of knee prosthesis such as posteriorly stabilized knee implants is required in obese patients to guard against ligament laxity following surgery.


  Summary Top


Obese patients deserve pain-free life as much as thin ones. Research has proven that risks, even though higher, far overweigh the disability and pain suffered by patients due to advanced arthritis.

In nutshell, knee replacement is a worthwhile endeavor in obese patients with advanced arthritis of the knee.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




 

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