Dear Doctor: Weight loss before knee surgery is helpful, but even patients with a high BMI see benefits – OregonLive

DEAR DR. ROACH: I’m 72, and I have had arthritis for three years: two years in both knees, one year in my right hip and the base of my spine. I am 5′3″ and weigh 221 pounds, with a body mass index (BMI) of 39. I lost 23 pounds from January to June.

What is the BMI needed for an orthopedic surgeon to do a hip replacement for someone with osteoarthritis — without a broken hip? I recently had an assessment of my hip X-rays. I was told I’m at the outer cutoff of a BMI of 39, so I’m eligible for a hip replacement operation. Then, a few weeks later, I saw the surgeon, who rejected me — claiming that 39 isn’t the outer limit, 35 is.

After a long talk, the surgeon said he’d do it for me, but I’d get a better result if I lose 20 more pounds and get my BMI down to 35. I felt jerked around, but said I’d wait and lose weight. I’m also trying to find a surgeon I like more than him.

So, what is the BMI needed for knee surgery: 35 or 39? — L.C.

ANSWER: There is no standard cutoff BMI for joint replacement surgery. It is true that people with a BMI over 40 are at higher risk for medical complications; however, it is also true that people with severe arthritis and a high BMI still get improvement in their quality of life with surgery. Denying a person a cost-effective surgery that can greatly improve their quality of life simply because of a BMI number (which, in itself, is a flawed metric) is inappropriate.

I can understand why you would want to see a different surgeon, as it sounds like you were not treated well. However, the surgeon was right that surgical outcomes are better if a person can lose at least 20 pounds, according to a 2019 study. This included shorter lengths of stay in the hospital and a lesser chance of needing surgical revision. I wonder, though, if part of the benefit seen in the study was due to increased exercise prior to surgery, which is known to be beneficial in surgical outcomes.</…….


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