The path to orthopedic surgery isn't easy. Most people spend months or even years living with joint pain and the loss of mobility. So for a patient to make it to an orthopedic consult only to find out that they need to lose a significant amount of weight before surgery can be done safely, the news can be unbearable.
A new coordinated care pathway at AdventHealth Bariatric and Metabolic Institute is easing this journey for obese patients who need orthopedic surgery. Our orthopedic and bariatric surgery experts are working together to remove the roadblocks to orthopedic surgery with access to surgical and non-surgical weight loss options.
“Some of our patients are well aware that their weight may be a barrier to orthopedic treatment,” says Dr. Brian T. Palumbo, MD, an orthopedic surgeon at AdventHealth. “What they don’t know — and what we want to help them understand — is that we can help them move forward with surgical and non-surgical medical weight loss programs that will make them better prepared for the orthopedic surgery they need.”
The first step, says Dr. Palumbo, is to help the patient understand the link between obesity and joint pain to help them take charge of their health and overcome any feelings of frustration or insecurity about their weight. Then Palumbo can refer them to the bariatric team at AdventHealth Bariatric and Metabolic Institute.
Obesity and Joint Pain Go Hand in Hand
Over the past 30 years, the percentage of adults living with obesity in the United States has more than doubled. Today, one in three of us is living with the disease. When you consider that one pound of body weight contributes to four to six pounds of pressure on each knee, it is no surprise that obesity has become one of the most common diseases to impact people's bone and joint health.
People with obesity are 20 times more likely to need a knee replacement than people who are not overweight. And not only does excess weight cause progressive wear and tear on our joints, it can also have detrimental effects on surgical outcomes. But orthopedic surgeons often have a hard time talking about these issues in a way that encourages patients to persevere.
“Historically, weight has been a very sensitive issue in orthopedics,” says Dr. Palumbo. “Surgeons are not trained to talk to patients about obesity and they rarely have resources at hand to help their obese patients, but in working with the bariatric program at AdventHealth we now know how to make those conversations positive and productive.”
How Weight Impacts Orthopedic Outcomes
Obese patients undergoing orthopedic procedures experience higher infection rates and are more likely to experience prosthesis failure or the loosening of an implant than patients at a healthy weight. Surgical operating times and the length of stay in the hospital after surgery are also longer with a higher Body mass index (BMI). And overweight patients are at a higher risk of complications including:
- blood clots
- blood loss
- dislocation of replacement joints
- infections
- non-healing wounds
Because being overweight and orthopedic conditions are so intertwined, the American Academy of Orthopedic Surgeons recommend that patients with a Body mass index (BMI) of 40 or higher work with their doctor to address their obesity prior to orthopedic surgery. Taking steps to lose and manage weight will protect you from serious complications and set you up for a better outcome — immediately after surgery and in the long run.
Lower Weight, Lower Risks
“We conducted a systematic review of literature by the AdventHealth Bariatric and Metabolic Institute,” says Dr. Michel Murr, a bariatric surgeon at AdventHealth and we found that bariatric surgery prior to total joint arthroplasty (TJA) decreased major and minor post-operative complications, operating room time, length of stay. In addition to 90-day readmissions after the procedure.”
Bariatric surgery is a safe and effective way to reduce weight. And over time, most people lose significant amounts of weight after bariatric surgery. That weight loss often resolves many of the comorbidities that influence outcomes of orthopedic surgery, such as diabetes and metabolic syndrome.
A New Path Forward
“AdventHealth’s new orthopedic and bariatric coordinated care pathway is designed to empower obese patients with compassionate, expert care. By treating the whole person — body, mind and spirit — we can help patients overcome the challenges of obesity and orthopedic pain”, says Dr. Murr.
“Once I refer patients to the Bariatric and Metabolic Institute, they are on the path to improved health,” says Dr. Palumbo. “While they work through the bariatric program, we remain in touch to assist with their needs until they are ready for surgery.”
The journey from referral to weight loss surgery and on to the orthopedic procedure may take anywhere from nine months to a year. Patients work closely with bariatric doctors and dietitians to prepare for surgery and to learn how to manage their weight afterwards. If they need pain management during the process, the orthopedic team is available to help.
Don’t let your weight stop you from getting the orthopedic care you need. If you think you could benefit from this new collaboration between orthopedic and bariatric care, contact us at
Call813-971-6000. You can also learn more about surgical weight loss in Tampa by watching our free online seminar.
