Being overweight need not be an impediment to safe and successful knee replacement surgery as long as a patient’s body mass index (BMI) is not above 40 and he or she is not suffering from certain medical conditions.

Health City Cayman Islands Chief Orthopaedic Surgeon and Joint Replacement Specialist Dr. Alwin Almeida, who is responsible for endoscopic treatments of joint diseases, said patients with a BMI of 40 or higher are generally advised to lose weight before surgery since overly obese persons are at a higher risk of surgical complications.

However, he added obesity is not an absolute contraindication to joint replacement surgery as several studies have shown that total knee replacement in patients with a BMI between 30 and 39 has been successful with acceptable complication rates.

Having more than 10 years of experience in arthroscopic procedures and joint replacements, he says an obese patient can have knee surgery but should be advised of the risk of complications such as infections and early loosening of the implants. Also, the patient should be counselled to become more active after surgery to lose weight and lower the BMI.

The orthopaedic specialist, who has a robust background in medical research and publishing, cautioned that obesity can lead to knee replacement failure if post-operative care and commitment to reducing BMI are not well managed, but a morbidly obese patient can have successful knee replacement once post-operative care is well managed. Dr. Almeida explained that those with knee sepsis, previously untreated or chronic osteomyelitis, an ongoing remote source of infection, and severe untreated or untreatable peripheral arterial disease are not recommended for surgery.

Stressing the importance of maintaining a healthy body weight, Dr. Almeida said that weight loss prior to surgery can lead to shorter hospital stays and discharge to homes rather than to rehabilitation facilities. For people with a BMI over 40, he said there can also be a higher risk of aesthetic complications.