Positive results on obesity and TKR Re: discouraged

[Guest guest]

Hi Gayle,

I¹m sorry that you had to deal with this jerk. It¹s hard to be told you are

too heavy for a surgery that you need and want. I think this doc is just

wrong and operating out of prejudice rather than fact.

You have three doctors who will do the surgery ‹ and I would ignore the

snotty remark about ³hungry² doctors and go for it. If you are concerned,

aske them about their experience with obese patients and what they know of

clinical studies.

Just do your pre-surgery exercises to strengthen the quads and other

supporting muscles, get as healthy as you can before surgery, and ignore

this doc! Of course losing some weight would be good. All of us who are

heavy find that carrying extra weight stresses the joints. But that does

not mean we should not have access to medical care.

This doc who won¹t do the surgery should be able to provide references to

clinical studies to support his statements about multiple knee replacements

and I would ask for them. If you are successful with this request, please

share them with this group. Cause that¹s not what I¹m finding in the

studies posted on the internet.

Meanwhile, here are some things I found by googling Œobesity¹ and TKR, all

from very respectable sources:

Here is one abstract on the net at

http://web.jbjs.org.uk/cgi/content/abstract/88-B/3/335

> A total of 370 consecutive primary total knee replacements performed for

> osteoarthritis were followed up prospectively at 6, 18, 36 and 60 months. The

> Knee Society score and complications (perioperative mortality, superficial and

> deep wound infection, deep-vein thrombosis and revision rate) were recorded.

> By dividing the study sample into subgroups based on the body mass index

> overall, the body mass index in female patients and the absolute body-weight.

> The outcome in obese and non-obese patients was compared. A repeated measures

> analysis of variance showed no difference in the Knee Society score between

> the subgroups. There was no statistically-significant difference in the

> complication rates for the subgroups studied. Obesity did not influence the

> clinical outcome five years after total knee replacement.

http://www.springerlink.com/content/p364jydduqpbvjua/

> The clinical and radiographic outcomes of 326 total knee replacements (TKR) in

> 285 osteoarthritic patients with body mass index (BMI) greater than 30 kg/m2

> were compared with the results of a matched group of 425 TKR in 371 patients

> with BMI less than 30 kg/m2. At an average follow-up of 75.9 (48-144) months

> the Knee Society score (KSS) in the obese patients had increased by 41.9

> points, and the joint score by 43.7. In the non-obese group the KSS rose by

> 40.2 points and the joint score by 42.6 points. Although patients with BMI

> greater than 40 kg/m2 achieved a lower final KSS the 'absolute improvement'

> appeared to be independent of BMI. Of the obese patient group 4.9% underwent a

> revision of their TKR, compared with 3.1% of the non-obese group. Although

> linear osteolysis (radiolucency) rates were comparable, focal osteolysis rates

> were 5 times those of control subjects when the BMI exceeded 40 kg/m2.

> Ten-year survivorship figures were similar for both obese and non-obese

> patients.

>

And from the National Institutes of Health NIH Consensus Development

Conference on Total Knee Replacement) at

http://consensus.nih.gov/2003/2003TotalKneeReplacement117html.htm

> There are few absolute contraindications for TKR other than active local or

> systemic infection and other medical conditions that substantially increase

> the risk of serious perioperative complications or death. Obesity is not a

> contraindication to TKR; however, there may be an increased risk of delayed

> wound healing and perioperative infection in obese patients. Severe peripheral

> vascular disease and some neurologic impairments are both relative

> contraindications to TKR.

>

And from US Deparatment of Health and Human Services Total Knee Replacement

summary at

http://ftp.ahrq.gov/clinic/epcsums/kneesum.htm

> Age, obesity, or gender do not seem to be significantly correlated with TKA

> outcomes.

I can¹t wait to learn that you have scheduled surgery with a doctor who

supports your desire for greater health and that you are on the way to a

great surgery and successful rehab! Just leave this guy in the dust!

Peace,

Jackie

--

Jackie on

Jackiett@...

R-TKR 3-19-09

L-TKR 9-1-09

Dr. Patch

On 7/10/10 12:16 AM, " Gayle " <keithandgayle@...> wrote:

>

>

>

>

>

> Hi,

>  

> Yesterday I interviewed another OS.  I've heard  he is an excellent surgeon

> and his patients have smooth recoveries.  He said he would not do my surgery

> unless/until I lost 60lbs.  " shrugs "   I was not really surprised...though

> disappointed.  What he said that does concern me is that if I don't lose this

> weight and go ahead with the surgery then I would end up having multiple knee

> replacements as years went on.  He said " you will probably be able to find a

> doctor who is hungry enough to do the surgery..etc etc " .  Needless to say...I

> left his office feeling defeated and hopeless. Out of the three doctors I have

> spoken to...he is the first to say he would not do the surgery.  I guess I am

> questioning how a knee replacement will last less time if, for my height, I am

> obese.  Would not a person who is taller and perhaps weighs the same...have

> multiple replacements as a result of their weight? 

>  

> I have decided to postpone my surgery in hopes of taking some weight off.  Not

> an easy task when one cannot walk very much.  I know that carrying alot of

> extra weight will make PT and recovery in general harder.  I feel I am in a

> catch 22. 

>  

> Just needed to vent..thanks for listening.

>

>