BMI and TKR

Posted by babette @babette, Mon, Feb 18 3:35pm

Has anyone encountered surgeons who will not do surgery in patients above a certain BMI?

I'm really in a bind: Surgeon 1 did my R knee and the 7 month recovery has been really difficult and painful despite extensive PT/stationary bike at home. I'd assumed he would do my L knee, but my confidence in him is fading. He has a reputation of being an excellent surgeon.

I read about the Conformis custom knee and went to see Surgeon 2 who requires me to lose weight before he will operate. I have really mixed feelings about this having read and experienced that most diets do not work/are not sustainable. He has me on an eating plan now and I've been compliant for 2 months without losing a pound.

Surgeon 1 never mentions my weight.

Thoughts and suggestions most welcome!

Hi @babette, I've struggled with weight most of my adult life. I'm 6'2" and got as high as 330 lbs which is when I decided it's not good for my health and joined Weight Watchers. I'm no longer a member but belonged for about 5 years and got my weight down to 230 lbs. What Weight Watchers taught me was that diets don't work and it has to be a lifestyle change. As hard as it sounds, once you make the decision and start making small changes it will help you in the long run. I'm now at about 240 but my weight fluctuates 5 to 10 lbs so I use that bracket to know when I have to buckle down a little harder. One of the books I read that taught me a little more about eating healthy was Dr. Terry Wahls – The Wahls Protocol. She has an amazing story to tell if you want to read more – https://terrywahls.com/about/about-terry-wahls/.

I'm waiting for a knee replacement myself but have not heard of having to lose weight for surgery unless it might be the surgeon thinks it poses more of a risk for a successful surgery. Mayo Clinic has some good tips here that may help:

The Mayo Clinic Diet: A weight-loss program for life
https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/mayo-clinic-diet/art-20045460

I think if it were me and the surgeon 2's plan wasn't working, I would make a few tweaks to his plan or try something different. What helped me early on was swapping out my breakfast for a yucky green smoothie ☺

Have you thought about trying any specific diets or changes in what you are eating? The real biggie (IMHO) is eliminating 99.9% sugar. Me, I'm still struggling with that one.

Good luck!

Hi – I'm so happy you had success with Weight Watchers and I agree that one has to change one's lifestyle and not think of eating as "a diet," but rather an eating plan/way of eating for life.

I have MS and have read Dr. Wahls. I just cannot eat 9+ cups of vegetables and the organ meats she advocates!

I'm eating lots of protein and good fat, "slow" carbs: veggies, mostly beans. Surgeon 2's colleague David Ludwig, M.D. wrote _Always Hungry?_ and that's the book he recommended to me. I can give up sugar. My downfall is potatoes. That's it. I love pasta and bread too, but can let them go if I can eat potatoes!

My PCP is very supportive and tells me that there are no good studies that point to weight loss being a factor in TKR outcomes. Lots of thin people have TKRs and have complications. Ditto almost every illness: she sees just as many thin people with health problems as she does large people. She's very fat friendly, even though she's a tiny woman. She also knows I have a very stubborn set point and that my body fights to hang on to every pound. This is so frustrating!

@babette

Hi – I'm so happy you had success with Weight Watchers and I agree that one has to change one's lifestyle and not think of eating as "a diet," but rather an eating plan/way of eating for life.

I have MS and have read Dr. Wahls. I just cannot eat 9+ cups of vegetables and the organ meats she advocates!

I'm eating lots of protein and good fat, "slow" carbs: veggies, mostly beans. Surgeon 2's colleague David Ludwig, M.D. wrote _Always Hungry?_ and that's the book he recommended to me. I can give up sugar. My downfall is potatoes. That's it. I love pasta and bread too, but can let them go if I can eat potatoes!

My PCP is very supportive and tells me that there are no good studies that point to weight loss being a factor in TKR outcomes. Lots of thin people have TKRs and have complications. Ditto almost every illness: she sees just as many thin people with health problems as she does large people. She's very fat friendly, even though she's a tiny woman. She also knows I have a very stubborn set point and that my body fights to hang on to every pound. This is so frustrating!

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I can relate to your plight ☺ Potatoes are one of my downfalls although I try to substitute sweet potatoes when I can. Bread is another hard one for me to give up. It's great to have PCP that is supportive. I won't be one of the thin ones recovering from a TKR (when I get it scheduled). I think the key is attitude and working on what helps your recovery. Don't give up…you got this!

I only know 2nd hand about someone’s knee replacement being delayed/postponed because of weight. Years ago I worked out at Curves, and there was a very nice 60ish woman who had joined to drop pounds in preparation for surgery. Always cheerful, she worked out as much as she could. EVERY time she managed to lose perhaps 20 lbs. or so and got on the surgery schedule, she stopped coming and went back to eating. Procedure got cancelled a few times, then I changed fitness centers, so I don’t know if she ever got a new knee. I agree with lifestyle change for permanent weight loss, even though I’m lucky that I never got above what’s considered normal weight. However, after being stationary at the same weight for roughly 20 years, I had a complicated dental implant in 2017 (difficult extraction, infection on jawbone, needed bone graft), whole procedure took roughly 6 months. Every 7 to 10 weeks my gums would be cut open again to do some work. Chewing on one side of the mouth pretty exclusively for those months was tiresome, slow, but I accidentally (and gladly) ended up dropping about 15 lbs. Made up for the inconvenience, cost (!!!), and pain. I wish you luck with both your diet(s), and your next knee surgery.

Thanks everyone. My dilemma is that I really want Surgeon 2 to do my surgery and he's the one with the BMI requirement. He does the Conformis knee. Sigh.

My surgeon made me lose weight before he would do my partial replacement. Because of my age (42 at the time) he was the only surgeon in town who would agree to operate.Unfortunately, at 15 months postop I'm still in a lot of pain and am seeking a second opinion out of town and am also working with a pain management doctor.

@babette Hi Babette. and welcome to Connect. I too have struggled with my weight all of my life. I have had two TKRs. One at a much higher weight and the second, in October 2017, a Conformis, at a significantly lower weight. I don't know if my surgeon (he's one of the developers of the Conformis knee) would have wanted me to lose weight if I had been at the higher weight but I have heard of surgeons wanting patients to do that. Many TKRs are necessary due to the patient carrying excess pounds, I am sure that contributed to mine, so it goes to reason that things will be better for you after the surgery if you lose the weight.

I needed a liver transplant so that really made me get serious about losing weight, knowing the recovery would be much better from that surgery. I lost a very significant amount of weight, getting my BMI from over 30 to about 26. It was not easy but I used some tools to help me. Frankly, I have back-slided a bit so I am trying to work up the will-power to lose about 10 pounds now.

First, I used myfitnesspal.com to really track everything I ate. It's amazing how those little tidbits can add up but when you have to put it down on a tracker it does make you stop. If you don't put include it on the food you have eaten that day you are only cheating yourself.
Second, I wore a fitness tracker to check up on myself that I was making the goal I had set. Fitness trackers run the gamut in prices but the one I used then was a Misfit, relatively inexpensive. I actually chose that one because at the time it was one of the very few that could be worn in water and a great deal of my exercise is in water aerobic classes and water jogging, which by the way is one of the two exercises that my surgeon most highly recommends, the other being my recumbent bike. They are both low-impact. The Misfit also meshes well with myfitnesspal, giving you extra calories on days when you have worked out a lot.
Third, I have a scale that not only weighs you but gives you BMI and fluid retention. I realize it's not medically accurate but it's a great gauge. When I see my BMI in the teens I know I am retaining fluid even before I check that figure. If you gain weight and see that your fluid is high it is better than thinking you have actually gained fat.
My scale is a Tanita that I purchased on Amazon around 5 years ago. At that time it was not more than $50. I went from plus sizes to a size 10 on the bottom, and larger on top — M or L.

My PCP was amazed and very happy at my weight loss. I think when you have a real incentive it makes it easier to say no to foods you know you should not have. My downfall is almost everything! I can do without pasta but I love good breads, and I do like sweets. I try to avoid sweets but am not always successful at that. At least when I confine myself to a little dark chocolate each day I can justify it by telling myself that it's good for your heart, and I read recently that it's good for your brain too!

Good luck with losing weight. Feel free to ask me anything, either via general posts of PMs. Having "been there" I am happy to help anyone else who needs encouragement.
JK

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