Dr. William Long responds to the growing trend of obesity leading to knee replacement and what this means for the field of orthopedics.
William Long, MD, is an orthopedic surgeon, founder and medical director of the Orthopaedic Computer Surgery Institute at Good Samaritan Hospital in Los Angeles. Ortho CSI uses computer navigated and robotic technology to assist in hip and knee replacement procedures. Dr. Long shares how this technology can help obese patients with no other choice but to undergo a joint replacement procedure.
Question: How do orthopedic surgeons respond to obese patients seeking surgical intervention?
Dr. William Long: Ortho CSI has special experience and equipment to care for obese patients that need knee replacement surgery. Most orthopedic surgeons avoid operating on obese patients. Some practices actually screen patients for appointments based on their height and weight. Many obese patients have experienced office visits where they feel unwelcomed. They are told that they are not a candidate for joint replacement surgery because they are higher risk for complications.
Q: How should orthopedic surgeons respond to the growing trend of obesity leading to necessary knee replacement?
WL: I believe that high risk patients should have the opportunity to benefit from joint replacement surgery just as low risk patients do. I also agree that every practice should not perform surgery on obese patients. The balance comes from acknowledging that obese patients need functioning knees just like non-obese patients.
Because of the higher risk to the patient, in most operating rooms it is ethical for some practices to turn obese patients away. I believe that orthopedic surgeons who do not provide this specialized care should refer them to a center that possesses the expertise to effectively care for these patients as oppose to expecting them to lose 100 pounds prior to knee replacement.
Q: How does your center cater to obese patients?
WL: Before surgery a team of pulmonary specialists evaluate every patient and determine the most effective way to prevent blood clots. The operation is performed using regional anesthetic techniques without general anesthesia. Patients breathe through a mask without a tube in their throat, breathe spontaneously without a respirator, and they inhale oxygen without inhaling anesthetic gas.
We perform the surgery through smaller incisions because computer navigation enables us to achieve precise limb alignment. This enhances the surgeon’s ability and gives patients confidence that the implants will be accurately positioned.
An experienced team of therapists allow most patients to walk within four hours after surgery. Smaller incisions, shorter surgery time, accurate implant alignment, and rapid ambulation decrease the risks associated with joint replacement surgery.
Q: What is your approach to treating obese patients after knee replacement has been done?
WL: We believe obese patients have a greater chance of losing weight after knee replacement surgery because they are now able to walk better. We encourage aerobic exercises such as aquatic therapy, stationary bicycle, elliptical machine and other low-impact exercises. We also refer patients to other healthcare professionals for group activities and weight-loss surgery.
Q: Do you think obese patients will always be forced to turn to surgical intervention for the stress placed on their joints?
WL: Surgeons have unsuccessfully tried to restore cartilage in the human knee. Everyone wants to believe that there will someday be a pill or an injection that restores cartilage, but currently no such product exists. The first scientist who can successfully regenerate cartilage in the human knee will most certainly deserve the Nobel Prize.
More Articles on Orthopedics:
Study: Outpatient Partial Knee Replacement Can Be Safe, Have High Satisfaction
Orthopedic Surgeon Roundtable: 4 Surgeons Discuss ASC Hip & Knee Surgery Challenges, Advancements
Specialization in Orthopedics Grows Over Past Decade