overweight and TKR

[brattkids]

Anyone here overweight with a TKR.

My husband is about 80lb  overweight and needs a TKR. He is 38yrs old. I am just wondering how much faster the implant will wear out than if he were to lose the weight. It is a double-edged sword with him he knows he needs to lose weight but his knee hurts so bad he can't even walk farther than about 15 steps without severe shooting pains. He has also tried the bikes without success because of his knee locking.

He is now watching what he eats but it is just not helping due to inactivity.

Are there any special implants out there for the overweight??

Thanks for your help 

Paulette

[mmaxell]

Hi Paulette - my story is similar to your Husband's except that I am 51.  I have had bi-lateral OA for ten years with it being bone-on-bone for the last three - ouch!!  I have lived in an invisible wheelchair.  However, my OS was kind enough to Never mention my excess weight and did my LTKR 10/17/06, two months prior to my 51st birthday.  He'd have done it six months sooner, except my schedule (as a Wedding Minister) would not permit it until Fall!  I had the RTKR done 3.5 months later on 2/6/07 and am now 3 months post-op from it! 

No one knows how long the mechanics of the TKR will last.  However, lately I've heard rumors of upwards of 30 years but 20 is probably a more likely a number!!  A reasonable amount of activity is expected, post TKR, but jogging or anything that would qualify as high-impact is not recommended. I figure by the time I need mine replaced, again, there will be better methods and improved appliances?!?!?

Has your husband talked with an orthopedic surgeon?  I think that if it is indicated that he Needs a TKR, they will not hesitate to set him up for one - regardless of his age/weight!  If he encounters an OS that is not sympathetic, fire him and find another one!!!

Good Luck ~ Melanie in PA

[rozzzie]

Hi Paulette,  I agree with Melanie, most OS's that specialize in replacements, weight is not a major issue.  I did have a couple say, you need to lose XYZ ; I was like your husband I worked out as much as I could, but could not do much.  I even had one say I needed to have gastric bypass before he would do it. NOT switched to a great OS and Have had no problems; I'm 14 and 17months, I see my OS next month for my yearly check up.

Good Luck

Rozzzie

[Teresa_S]

The weight issue is up to the individual OS. Some will NOT even discuss it with somebody they consider too overweight, but I think this may be around 100 pounds or so over the ideal weight. I have had patients that weighed 225-250, and maybe they are harder for the staff to get up and going, and depending on how sedentary they were before, as many could not begin to walk afterwards any hallway, etc, and could not peddle as they could not even get on the bike. They sort of ended up with a cane and a knee that just did not hurt as much. There is a guy close to us that went to the state medical university, but he weight around 400 or more and they told him to lose at least half his weight and maybe they would consider, but this guy was active in away on his farm.He fell and really can't walk now, but they told him no. Other Os don't mention weight. I think they should openly discuss if they think it will affect the life of the prosthesis, or inhibit the recovery. I Also know of back surgeons that  tell patients, if they are 50 pounds overweight or have a big abd. there is no use to have surgery as they won't be helped
.

There are those that do well or don't do well, regardless of their weight. I would check out a couple of OS and get their feel. Would look for one who was willing to work with him. He has his age and weight aganst him. He needs an understanding Os . Plus extra weight on a 6 foot of more frame, is not nearly as incapactitating as on a 5 foot or so frame 
Good luck, Teresa

[jathib]

As the other posters have mentioned, some doctors will do the surgery regardless of weight, and some won't. It's just a matter of finding one who will. That being said, it would be in your husband's best interest to get in the best shape he can. Swimming is the best possible thing for him. He doesn't need to swim, he just needs to get in the pool and move. Most pools have kickboards, etc. for people to use. I don't know where you're located, but if you're not near a YMCA or something then check local hotels, high schools, colleges, etc. Many of them have pools that they open to the public for a small fee. Besides swimming, he will also need to strengthen his upper body. People usually neglect this area before surgery. But after knee surgery you need to be able to maneuver yourself around to get in and out of bed, chairs, etc.

[DRSKIER]

Most OSs will tell you that 200 pounds is the weight you want to get under!! Success rates and longivity rates take a dramatic shift once the weight is over 200 pounds...Try to get under 200 and maintain it!  Try swimming, elliptical machines--anything that will increase your activity and not pound on that knww...

[brattkids]

I just want to thank everyone for your replies!!

My hubby is seeing an OS and the reason we have to wait for a TKR is because he contracted MRSE last fall and he has to be at least 1 year infection free before he can be considered for the TKR. His OS has told him to try and lose 50-70lbs but will not rule him out just because of his weight. Our issue is that the TKR will wear out faster and with his age he really doesnt want to be wheelchair bound in his 50's or 60's. I am so hoping that with the TKR he will lose some weight because he is able to move more with less pain. He also has high cholesterol (on statins to control) so I am worried about the heart issues as well with the extra weight. I know anesthesia is harder with extra weight also.

Hopefully watching diet at this point will help

Thanks again to everyone

Paulette 

[Teresa_S]

I had MRSA in my knee, and we waited the year, but the first tkr did not ever respond correctly. IT was never stable, and hurt constantly. I had the spacer revised a year later, as the screw backed out, and the spacer was worn exactly like the knee had , in only one year. Then I had a tkr revision surgery, with a long stemmed prosthesis that is stabilizing put in on Jan 31, 2007. It is still a painful, long recovery. The surgeon made sure there was no infection, pre op,with blool and cultures. Then did a Bone scan, all of which I am sure the os will want of your spouse too. Hopefully all will go well, and he should recover well, esp, if he has to absolutely push now and disreagard the pain. Good Luck Teresa

[brattkids]

Theresa,

I sure hope that is the protocol to test for infection because of the infection risk. I have a silly question. The long stems do they go in both the tibia and femur?? I am asking becsue my husband had a HTO in 2003. Would they still be able to use that on him??

Paulette

[Gary064]

Hi Paulette,
               I am 48 and weigh 310 pounds. I had my TKR 11 weeks ago and all is going well so far. My OS recommended that i did lose some weight before the operation but as i had severe mobilty problems this was an issue. The main thing i can recommend is get your husband to visit a physio to get his muscles built up before the operation as he will get a lot of muscle wastage. I did this and it helped a lot i was discharged from hospital 4 days after the operation.
    My OS also told me that although the new joint normally last about 15 to 20 years as i am overweight the joint may only last 8 to 10 years, so it would be in your husbands best interest to try and lose some weight as i have started doing as i am more mobile now.

I hope this helps and give your husband all my best.

Gary

[costumer]

               I am 48 and weigh 310 pounds. I had my TKR 11 weeks ago and all is going well so far. My OS recommended that i did lose some weight before the operation but as i had severe mobilty problems this was an issue. The main thing i can recommend is get your husband to visit a physio to get his muscles built up before the operation as he will get a lot of muscle wastage. I did this and it helped a lot i was discharged from hospital 4 days after the operation.
    My OS also told me that although the new joint normally last about 15 to 20 years as i am overweight the joint may only last 8 to 10 years, so it would be in your husbands best interest to try and lose some weight as i have started doing as i am more mobile now.

 Oh I'm so glad I found this thread!

    Gary, how are you doing? Are you back working? How was the initial rehab?

    I'm looking at a similar situation: I'm 47ish and around the same weight (I guess, I banished scales, they just made me too depressed) and I need bi-lat TKR. My OS isn't happy because I'm so young and overweight - he's been trying to push sotmach surgery on me! Although I'm not a candidate for it, I really resent the American drs pushing so hard for a proceedure where 1 - 2 person in 50 die from the proceedure! that's terrible. sure, I'd love to weigh less, but neither diet nor excersize has ever really done much - must be genetics or metabolism I guess <sigh>. And of course now I'm so immobile that even with a cane I can't even stand up straight. I can barely walk in small bits, how the heck can I excersize?

    I understand that how long the implants last will be compromised; heck, the originals are compromised more than I can stand. I thought someone had told me that getting the TKR when one is overweight doesn't work well.. i"m so hope you're doing well!  yeah, I'm a little spazzy about the whole thing here.

    anyone else here similar with weight issues and bi-lat TKRs? How has it been??

          -Judy

[Teresa_S]

Paulette, sorry for the delay . THe protocol, is to draw some fluid and send it for cultures, get a bone scan, and a ESR and CPR to try to rule out all chances of infection. Then when they open the knee for the tkr, they also send more fluid,tissue for culture,and don't proceed if there is any chance of infection. I believe they will be pretty diligent about this, as the knee will fail, and involve the antb. spacer, healing IV atbs, etc, and they don't want that.  More than anything, to pepare for the tkr, your husband would benefit from a daily program of walking, and getting his quads to fire before the surgery. I had the HTO recommended too,but just kept putting it off till tkr was the only choice, so just bypassed it . Make sure you have a surgeon who is trained in reconstruction, and the newest techniques. He will also need a customized type prosthesis,I imagine. My original tkr left the bone cut at an angle, that had to be compromised for, and also too much bone was tken. so the customized implants allow for all these things, in that they can augment, and use a different size tibial as opposed to femoral, rather than a set size  for all components. I will say, I have had a lot better luck using a joint reconstructon specialist, and the customized implant I had asked about what size he thought he would use, as the original OS used this huge implant for me and I am 5 ft 5 ins. 150 pounds or so, and it was made for over 6 ft 300 pounds plus . HE just cut too much bone to get to "good bone' as my bones had softened over the years, and he needed to have something the prosthesis could adhere to. Why he left it cut at an angle is beyond me other than my tibia was worn at an angle and maybe he thought he was  allowing for them to aling by leaving the opposite angle. BUT this time they had to augment one side alot more than the other to align the tibia. Teresa

[Gary064]

Hi Judy,
          On Monday i will be 12 weeks post op. I have to admit that the rehab bit is a bit hard but getting easier every week. Yes, being overweight is a problem but it is something i have to deal with. Doctors etc think it is so easy to lose weight, try being in my shoes, it's not especially with mobility problems.
         
          Last year when my OS put me on the waiting list for the TKR he had no problems doing the operation but recommended that i lose the weight so that the new joint would last longer, so really it is yours and mine best interest to lose some weight.

          Don't let your surgeon talk you into the tummy op, is there a weight loss program they could put you on? the op seems a bit drastic to me. Try not to worry yourself too much, when you have your knee done you will wonder what all the fuss was about, you will have pain and stiffness but not as bad as the pain you have now. If you read my post op diary you will see that i go through a lot of ups and downs and i moan a lot. Basically i am a very impatient guy but really i should be very thankful for what i have got now.

    All the best

    Gary

[costumer]

          On Monday i will be 12 weeks post op. I have to admit that the rehab bit is a bit hard but getting easier every week. Yes, being overweight is a problem but it is something i have to deal with. Doctors etc think it is so easy to lose weight, try being in my shoes, it's not especially with mobility problems.

     oh the choir so hears you They keep trying to tell me it's a 'simple' matter of calories in vs what you burn. geez, if it was that simple no one would be overweight!
         
          Last year when my OS put me on the waiting list for the TKR he had no problems doing the operation but recommended that i lose the weight so that the new joint would last longer, so really it is yours and mine best interest to lose some weight.

          Don't let your surgeon talk you into the tummy op, is there a weight loss program they could put you on? the op seems a bit drastic to me.

      Me too. No, I'm not going to do the surgery. I wish there was something that would work: it's been the bane of my life. The only time I was 'thin' was when I had stopped eating entirely and was depressed and suicidal. I really don't want to go back to that. In general I'm very happy and enjoy my life - well, I'd enjoy it a lot more if my knees weren't so trashed. Excersize (even if my knees would let me do any) oddly seems to work backwards with me: dunno why becaue I'm not eating differently, but it makes me gain and then after about 2 months my system shuts down and I can't even do it anymore. very wierd.

Try not to worry yourself too much, when you have your knee done you will wonder what all the fuss was about, you will have pain and stiffness but not as bad as the pain you have now. If you read my post op diary you will see that i go through a lot of ups and downs and i moan a lot. Basically i am a very impatient guy but really i should be very thankful for what i have got now

   thanks. I guess I'm spazzing so much because it's been 25 years since my last major open proceedure and I'm not as young as I was. The whole thing with the pain and uncertainty is getting to me. and I'm not happy about that either, lol!  I'll have to go find your post-op diary and see how it's been going. I'm glad you doing well. I figure I've got one of the top OS around, but if he won't do it, then I'll have to find someone else. I don't want to, but I'll have to. I'll be out of business and bedridden otherwise. I think the OA is still growing from the feel of the knees.

             -Judy

[Incog-knee-to]

Hi,

I have to relate a story here.  I have a good friend whose husband is overweight and has two arthritic knees.  He was always in terrible pain and walked with canes.  His OS told him that he needed TKRs (he is in his mid 50's).  My friend has been urging him to lose weight for years and he finally decided to do it.  He went on the No Flour, No Sugar Diet (Dr. Gott) and started walking.  When he started he could not walk very far or very fast, but he continued.  To date, he has lost 60 pounds and says that his knees feel better than they have for years and years.  He is not even considering TKRs now as the pain that is remaining is very bearable (his words).  He is up to walking 4 miles every day and feels and looks great. 

I know that it is not easy to lose weight with bad knees, but it is doable.  I just thought that I would post this as an encouragement for those that are carrying around extra weight on bad knees.

Best of luck to everyone.