Lose weight before knee replacement

Q: My sister-in-law is 55 and morbidly obese. She can’t walk very well, so she had bariatric surgery and then later she’s having a knee replacement. Is that double barrel surgery really necessary?

Belinda, K., Chattanooga, Tennessee

A: Having bariatric surgery before a knee or hip replacement is not uncommon for obese patients. In fact many times a surgeon will refuse to operate on a morbidly obese patient (with a BMI of 40 or more or 100 pounds or more overweight) until they lose substantial weight. That’s because morbid obesity is associated with poor postoperative outcomes after total knee and total hip replacement.

Before joint replacement surgery, if movement is impaired because of severe joint pain and erosion, it’s hard to exercise and shed pounds. That just compounds the health challenges associated with having obesity. After a joint replacement, obesity makes it difficult to do the post-op therapy needed to make the operation a success.

The bottom line is that bariatric surgery is a very effective way to lose weight before a knee or hip replacement. It can reduce postjoint replacement hospital stays and cut the risk of post-op complications, while improving overall patient health. In one recent study, researchers in the U.K. tracked 7,400 obese individuals who had bariatric surgery and found that it reduced their risk for a major adverse cardiovascular event by 59% compared with a control group.

The benefits don’t stop there: Bariatric surgery also results in the remission of Type 2 diabetes because of enforced caloric restriction, enhanced insulin sensitivity and increased insulin secretion. Thirty percent of overweight people have Type 2.

And obesity is thought to account for around 85% of cases of Type 2 diabetes.

So there you have it. Besides giving your sister-inlaw the chance of a shorter and more effective rehab after her joint replacement, bariatric surgery can boost heart health and can result in remission of Type 2 diabetes.