Total hip arthroplasty (THA), or hip replacement surgery, is a procedure designed to relieve pain and restore joint function, especially for individuals with severe arthritis. While the primary goals are pain relief and improved mobility, patients often wonder if weight loss is an additional benefit. This article explores the complex relationship between hip replacement surgery and weight loss, examining the impact of obesity on surgical outcomes, the likelihood of weight change after surgery, and the lifestyle modifications that can contribute to overall health.
Obesity and Hip Replacement: Understanding the Risks
Obesity, characterized by an excess accumulation of fat that poses a health risk, is a significant concern for individuals undergoing total hip and knee replacement. Body mass index (BMI), a ratio comparing weight to height, is used to assess a person's weight status. A BMI over 30 indicates obesity, and a BMI over 40 signifies extreme obesity.
Studies show that individuals with a BMI above 40 are more prone to experience complications during and after surgery compared to those with a lower BMI. Obesity has been shown to increase a person’s risk of having a medical or surgical complication after joint replacement, such as wound healing problems and infection. Treatment of some of these complications can include one or more additional surgeries and are potentially limb or life-threatening issues. Obese patients are also more likely to have medical comorbidities, including diabetes, cardiovascular disease, metabolic syndrome, malnutrition, and obstructive sleep apnea.
The joints in our legs carry the weight of our bodies every day when we do our normal activities, such as walking, standing, running, and climbing. The more weight we carry around, whether it is muscle or fat, the greater the load on our hips and knees. This is one reason why heavier people are more likely to require total hip and knee replacements than patients with normal BMIs, and why the risk increases as your BMI increases.
Because of these increased risks, some surgeons, hospitals, and insurance companies have adopted BMI cutoffs above which they recommend against joint replacement surgery to limit the risk of complications in patients with higher BMIs. Some surgeons and hospitals have developed programs aimed at reducing the risk of medical or surgical complications in high-risk patients, including those with obesity. These programs have shown promise in reducing the impact of increasing BMI on the risk of medical and surgical complications.
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Weight Loss Before Surgery: Is It Necessary?
One of the most frequent questions asked by overweight patients is whether their weight will affect the success of their hip replacement surgery and if they should try to lose weight before the operation. There are a number of suggested ways that patients can improve their chances of positive outcomes after surgery and at the top of the list is losing weight. This is because being overweight increases the risks of serious complications from joint replacement surgery.
Research findings presented in Osteoarthritis Cartilage in January 2020 considered 67 studies involving 581,012 obese and 1,609,812 non-obese patients who’d undergone total hip replacements. The study showed that obese patients had a higher risk of all types of complication. In particular, they were more likely to develop deep infections, superficial infections and dislocations. Researchers also considered morbidly obese patients and found that the risks were even higher. Patients who are obese are also more likely to have health conditions that can affect breathing and it may be difficult to ensure sufficient airflow and oxygen during surgery. After surgery, someone with a BMI over 40 is also more likely to experience complications including infections, blood clots, pulmonary embolism and wounds being slow to heal. Carrying excess weight puts additional pressure on an artificial hip implant and increase the likelihood of it becoming loose or dislocated.
However, a study published in the Journal of Bone and Joint Surgery found that obese patients have comparable pain relief and functional outcomes after surgery. The aim of the study was to evaluate the extent of pain relief and functional improvement in total joint replacement patients with various levels of obesity. Prior research has documented that obesity is associated with a small, but increased likelihood of infection after total knee replacement, which may discourage obese patients from having surgery.
Will Hip Replacement Surgery Lead to Weight Loss?
Many patients hope that hip replacement surgery will "free" them from their inability to lose weight by allowing them to be more active. However, research suggests that this is not always the case.
A study in The Journal of Bone and Joint Surgery examined 6,929 patients who underwent either hip or knee replacement for osteoarthritis. After 2 years, 73% of people in the hip replacement group and 69% in the knee replacement group had no change in their BMI. Those in the knee replacement group were more likely to lose weight than those in the hip replacement group. Also, the heavier (higher BMI) the patient prior to surgery, the more likely it was for the patient to lose weight. Only 7% to 9% of normal weight individuals lost weight, whereas 33% to 35% of extremely obese patients lost weight. Regardless of BMI or body weight prior to surgery, 9% to 16% of people gained weight after their surgery.
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Better results of the surgery were observed in those patients who lost weight after their hip replacement. However, this was not observed in the knee replacement group. For those who gained weight after the joint replacement, regardless of if it was a hip or knee, there was a greater likelihood of a poorer clinical outcome at 2 years. Increasing age was associated with a decreased likelihood of gaining weight; and being female was found to be a significant predictor of weight loss. The more functional the patient was prior to surgery, the less likely they would gain weight after the surgery, tending them towards improved clinical outcomes.
A retrospective analysis of 100 patients who underwent THA showed a general mean increase in BMI of 0.4 kg/m2. The BMI increased both in patients with normal weight and in those who were overweight, but it decreased slightly in patients who were obese. The postoperative analysis showed that there was a tendency toward weight decrease in 36 patients (36%); 15 did not present any weight change (15%), but 49 gained weight (49%). It was observed that there was a tendency for patients with lower BMI to migrate to higher BMI. Patients in the group with normal BMI migrated to the overweight group, while patients in this group migrated to the obese group after the operation.
These findings suggest that while some patients may experience weight loss after hip replacement, it is not a guaranteed outcome. Factors such as pre-operative BMI, gender, and pre-operative functional status can influence weight changes after surgery.
Lifestyle Modifications for Weight Management and Improved Outcomes
Regardless of whether weight loss occurs after surgery, lifestyle modifications are crucial for improving overall health and optimizing the benefits of hip replacement.
Diet and Exercise
Making lifestyle changes such as getting more exercise and eating a healthy balanced diet will not only improve your surgical outcomes, it will also help you to feel better and make a better and more rapid recovery. Lifestyle modification, consisting of changes in patterns of dietary intake, exercise, and other behaviors, is considered the cornerstone of overweight and obesity management.
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Losing weight by making appropriate dietary changes and increasing the calories burned each day through water exercise programs and other aerobic, non-weight bearing activities is always appropriate to decrease the risk of complications for overweight patients.
Improved weight parameters when compared to North American adults. Even a 5% reduction in body weight can help reduce pain and improve joint function. The more weight you lose, the better your results, before and after surgery.
Smoking Cessation
If you smoke, it is recommended that you stop smoking at least 4 weeks prior to surgery to decrease your risk of complications, such as problems healing your incision or an infection.
Cardiovascular Health
Improving the fitness of your heart and lungs and keeping your blood pressure under control can help reduce your risk of medical complications.
Bariatric Surgery
Bariatric surgery is effective for reduction in weight, though it has not been shown to reduce the risk of complications after surgery.
The Importance of a Holistic Approach
It is important that physicians and patients realize that no one factor is involved in the battle against the waistline. It is a combination of proper diet, exercise, and healthy lifestyles. When discussing life after joint replacement surgery with your physicians, it is important to remember that the most recent data point to improve results and clinical outcomes with subsequent weight loss, while inferior results are seen with weight gain.
Keep in mind that obesity is only one risk factor for medical or surgical complications and needs to be considered along with the rest of each patient's medical conditions. Some risk factors, such as age and family history, are beyond your control.