By Geoffrey A. Wright, MD
Statistics say one in three obese people have arthritis, and that number may even be higher. Obesity increases the risk of getting certain types of arthritis and makes all types of arthritis worse. There is good data showing that almost one third of the population 50 years or older has been diagnosed with arthritis, not just those who are obese. Arthritis is a rampant issue.
We frequently see these issues affect patients’ knees, but the importance of maintaining a healthy weight comes into play with hip replacements, too. In the U.S., more than a million knees and 400,000 hips are replaced each year.
Every pound of excess weight exerts about four pounds of extra pressure on the knees. So a person who is 10 pounds overweight has 40 pounds of extra pressure on his or her knees; if a person is 100 pounds overweight, that is 400 pounds of extra pressure on his or her knees.
People may not realize the knee joint, while going up and down stairs, bears up to seven times body weight.
Excess weight strains joints, wearing down cartilage, and leading to arthritis. Plus, fat itself is active tissue that creates and releases chemicals, many of which promote inflammation throughout the body. This often results in a worsening of the pain from arthritis.
We often must have difficult conversations with patients. Some may have been trying to lose weight their whole lives, while others start trying after they see us. Much of it has to do with the convenience of fast food in this country. Maintaining a healthy diet and an active lifestyle can be difficult.
We talk about diet changes, including more fruits and veggies and reducing carbohydrates, sweets, soft drinks and fast food. The first thing we tell patients is to keep a food log. They are often surprised at how much and how many calories they consume. There are some good apps to help monitor food intake and activity. Sometimes we will refer patients to a nutritionist or weight specialist.
We also talk about exercise, increasing activity slowly rather than becoming a weekend warrior. Even a quarter-mile or half-mile walk can help jumpstart a healthy routine. Swimming is a great option because of the buoyancy of the water as well.
As we age, we get weaker, so keeping the muscles strong has been shown to have significant benefit. Pain in the knees actually decreases as patients build muscle.
Being obese also increases potential complications n joint replacement surgery – increased infection, increased loosening of components AND increased instability – all of which are associated with increased revision rates. So we try to get patients to lose weight beforehand.
Those with a body mass index (BMI) of over 40 have a higher complication rate. That rate goes higher, and even doubles, for those with a BMI over 50. And these are not simple complications — we can see infections and additional issues that cause significant problems.
We have a responsibility to patients – not just the surgery itself, but also helping them create a healthier lifestyle and throughout the recovery process as well.
Geoffrey A. Wright, MD is a total joint specialist with Sports Medicine & Orthopaedic Center (SMOC). www.smoc-pt.com
