joint replacements

Obesity, Bariatric Surgery & Joint Replacements: Pre-Surgical Weight Loss

February 12, 2018

For millions of Americans, osteoarthritis is a very painful way of life. For a good number of those, joint replacement is the only gateway to finding relief from the debilitating aches and agonizing discomfort. So, imagine the disappointment when patients hear that they cannot find relief from their daily suffering until they lose 20, 30, or 40 lbs.?

This is the reality for many obese patients. Yet obesity is one of the most common diseases that adversely affect bone and joint health, according to The American Academy of Orthopaedic Surgeons (AAOS). In fact, AAOS indicates that individuals who are obese are 20 times more likely to need a knee replacement than those who are not overweight.

The Prevalence of Obesity in American Lives

A recent study by AAOS dove into obesity and revealed that more than two-thirds of adults in the United States are overweight, with one in every three classified as obese. The percentage of adults suffering from obesity has more than doubled during the past 30 years, from 15 percent in 1980 to 35 percent in 2010. Frighteningly, approximately 17 percent of children are currently classified as obese, which is triple the rate from just one generation ago. If the trend continues, it’s estimated that by 2030, 44 percent of American adults will be diagnosed with the disease.

For someone who has spent a lifetime struggling with obesity (trying diet after diet with little-to-no results), and who likely has many weight-related co-morbidities (including deteriorating joints), to be told to lose weight before surgery can be shattering.

Why Pre-Surgical Weight Loss is Recommended

Osteoarthritis is a common ailment in adults, and obesity is a major risk factor for this condition. Joint replacement surgery is a treatment for end-stage osteoarthritis.

However, obesity has been shown to increase the risk of surgical complications, including perioperative respiratory problems, thromboembolic events, delayed wound healing, infection, and the need for revision surgery.

Orthopedic surgeons frequently have weight limits for their surgeries, and many require patients to lose weight in preparation for joint replacement. The reason for this is to give patients the opportunity to achieve the best possible outcomes, including a safe surgery, quick healing, and the ability to regain mobility relatively soon.

Bariatric Surgery: When Diet and Exercise Fail

Obesity is a disease. For many people, diet and exercise simply don’t work to generate meaningful, long-term weight loss. Losing weight isn’t easy – especially when you’re in chronic pain with limited mobility.

Because nonoperative means, such as diet and exercise, may be inadequate for weight control, patients are often advised to consider bariatric surgery for more effective weight-loss treatment. In addition to reducing the risk of surgical complications, reducing excess weight also helps to diminish the difficulty of joint replacement surgery, allowing for the surgery to be performed with smaller incisions, which is a significant benefit to patients in recovery.

In addition, mobility is improved in a less obese patient. Several recent studies have confirmed that patients undergoing bariatric surgery prior to hip or knee replacement surgery have substantially shorter orthopedic operating times, a decreased length of hospital stay, and lower in-hospital and 90-day complication rates.

With this in mind, your decision to undergo surgical weight management is by no means one that is made – or should be made – lightly.

The benefit from bariatric surgery is not just weight loss, but also better overall health with improvement or even resolution of obesity-related conditions, including diabetes, sleep apnea and hypertension.

Many patients have been shown to have improved joint pain, not only from the reduced mechanical load but also from a decrease in inflammatory processes from metabolic factors after bariatric surgery. That’s really good news for a patient suffering from joint pain, or one needing joint replacement surgery.

The Timeline Between Bariatric and Joint Replacement Surgery

Both bariatric and orthopedic surgeons are frequently asked about the best timeline between bariatric and joint replacement surgery. Unfortunately, the optimal time interval for joint replacement surgery following bariatric surgery has not yet been defined. The reason is due to the handful of potential side effects from certain surgical weight loss procedures.

More specifically, nutrient deficiencies may affect muscle mass, bone density, and wound healing for surgeries, such as a Roux-en-Y gastric bypass or duodenal switch. Because of this, bariatric patients are required to take vitamin and mineral supplementation after surgery. Some of the restrictive bariatric surgeries such as sleeve gastrectomy have less of an effect on intestinal absorption than Roux-en-Y gastric bypass or duodenal switch. However, once a new baseline weight has been achieved, usually one to two years after bariatric surgery, the patient has substantially improved preoperative health and can obtain maximal benefit from joint replacement surgery. And while they’ve been losing weight, they have also been easing the burden on the troubled joints slated for surgery.

Deciding if Bariatric Surgery is Right for You

So, you know you need to lose weight. Where do you go from here? Research is the first step.

  • Determine whether weight loss surgery is right for you. To make it simple for patients and their research, we have an online quiz that potential patients can take to figure out whether they would be a good candidate for surgery.
  • Get to know bariatric surgeons in your area and attend an education session about weight-loss surgery. We strongly encourage potential patients to bring family or friends with them to learn more about bariatric surgery, and to ask questions they may have about various aspects of pre- and post-surgery, along with life after surgery.
  • Next, ask questions! Educational sessions provide a lot of useful information, and not just from the surgeons who have conducted hundreds (if not thousands) of these surgeries. Attendees ask some wonderful questions.
  • Speak with former patients, especially those who may have had similar circumstances, including needing weight loss surgery prior to joint replacement surgery. They know what you’re going through and can inform you about their experience. It’s a terrific opportunity to learn not only about both surgeries but also what to anticipate.
  • Have an honest discussion with both your orthopedic surgeon and a bariatric surgeon about realistic outcomes of both procedures. They are your partners in good health and want you to achieve your goals so that you can live a happier, healthier and more active life.


Daniel T. Fang, MD, FACS, FASMBS is board-certified by the National Board of Medical Examiners and the American Board of Surgery. Dr. Fang received his medical degree from the University of Maryland School of Medicine. With extensive experience in a wide range of bariatric surgical procedures, Dr. Fang is affiliated with the Bridges Center of Surgical Weight Management at St. Luke's Medical Center in Phoenix and Mountain Vista Medical Center in Mesa, AZ.