By Tegan Johnson-Galvez, DPT, and Jennifer Laity, M.S.
According to the Journal of Bone and Joint Surgery, obesity is a serious problem complicating orthopedic surgery. If you are thinking about orthopedic surgery in the near future research shows profound benefits to losing weight prior to surgery.
Many people feel that they are not able to lose weight due to joint pain prior to surgery. However, studies show that there is no evidence that patients lose weight after their orthopedic surgery. Furthermore, reduced activity during the recovery period after surgery often results in weight gain.
Gait studies have shown that the walking mechanics of people with elevated Body Mass Index (BMI), which is a ratio of weight vs. height, are significantly different from a control group of people with average BMI. It is suggested that these variances in walking mechanics are partly responsible for degeneration of cartilage in the knee joint. Reduction of BMI prior to knee surgery may help you to change your mechanics and prevent recurrence of pain and undue stress on the joint after surgery.
Elevated BMI has also been shown to complicate the surgical protocols. Often more portals are needed in arthroscopic surgery, longer incisions for open surgery, and the surgical times are longer for patients with higher BMI. The cost of surgery is also higher due to the longer surgical times as well as the use of specialized tools for larger patients.
BMI is also a predictor for patients’ outcomes after surgery. Those patients with lower BMI reported greater success after surgery based on higher functional levels and lower levels of pain. Those with higher BMI (greater than 30) reported longer recovery times and prolonged return to work. In addition, those with a BMI of greater than 30 have a higher probability of having a second total joint replacement.
If you do not know your BMI, start by going to a BMI calculator to find out where you stand. You may also stop by any BaySport clinic and a staff person will be happy to help you calculate your BMI or perform a body fat test with skinfold calipers to give you an idea of how much body fat vs. lean body mass you have. Once you have these numbers you can strategize with one of BaySport’s personal trainers, exercise physiologists or fitness specialists, and of course, your own physician to determine the best steps for you to take to meet your weight loss goals.
When your exercise options are limited by an orthopedic problem, your diet becomes the most important factor in managing your body weight. Since your activity levels are likely decreased, your need for energy is greatly reduced. The key to weight loss is controlling your intake of simple forms of energy such as sugars and grain-based carbohydrates, especially flour-based grains (even whole wheat). Eating a diet that is primarily plant-based, including greens, vegetables, fruits, beans, lentils, nuts, and seeds, supplemented with quality proteins and fats from pasture-raised/grass-fed animals and sustainable seafood, provides a healthy balance of nutrients. Minimize your intake of sugars, especially high fructose corn syrup, artificial sweeteners, flour-based grains (bread, pasta, cereal), and highly processed snacks and convenience foods. By minimizing your intake of sugars and grains, and increasing your intake of other plant-based foods with some healthy fats and proteins, you can keep your metabolic hormones under control, minimize storage of excess body fat, reduce inflammation, and ultimately improve your chances for a positive surgical outcome.
Reference:
“Obesity and symptomatic osteoarthritis of the knee.” www.ncbi.nlm.nih.gov. Journal of Bone and Joint Surgery Br. 2012 Apr; 94(4):433-40. http://www.ncbi.nlm.nih.gov/pubmed/22434455.