Obese patients sometimes denied repla...

Obese patients sometimes denied replacements for knees, hips

There are 61 comments on the Birmingham News Online story from Mar 6, 2006, titled Obese patients sometimes denied replacements for knees, hips. In it, Birmingham News Online reports that:

As demand for knee and hip replacements grows, many surgeons are turning away some patients who need the procedures most: the overweight and the obese.

Join the discussion below, or Read more at Birmingham News Online.

big ray

Ocala, FL

#23 Feb 3, 2014
Dawn wrote:
Well, today is my husband's 45th birthday, and he weighs 343 lbs. When he was 17, his right hip was fused, thus leaving him with one hip. It is expected, according to the research I have done on hip fusions, to have lower disk problems and eventual problems in the other hip joint over time. This has happened. He has been going to the original surgeons son, who is in the same practice now in Gainesville, FL. This dr REFUSES to do the surgery until he is down to 250. His hip has failed and he has fallen a few times. He is now on a walker. UNBELIEVABLE! We still have so much life to live, and have a 12 year old daughter. He has lost 23 lbs since his first visit, is in extreme pain, which I'm sure you all know how it feels. The dr will not budge. "See the pain mgmt dr" they say. They also gave me the phone number for Shands in Gville, who, will also not do the surgery. We have an appt with a surgeon in Ocala, who we hope will consider it. If not, my husband is looking at going on disability. Just had an xray done Tuesday...absolutely NO space in the joint. Totally gone. I just cant believe no one will help! Wish us luck.
Dawn, I'm looking for a doc in ocala, fl where I live... did u have any success?

Hamden, CT

#24 Feb 17, 2014
I had THR in CT. At the time I was 56 years old, 5'1 and about 260. The first surgeon I saw said I had to lose at least 75 pounds. I was bone on bone and in constant pain. The second surgeon agreed to do the surgery although he required me to have a panniculectomy (removal of stomach apron) before the THR to minimize infection in the incision. The panniculectomy was a HORRIBLE surgery and recovery. I had the THR 6 months later and that was a major success. I had walked with a cane for 9 years and after THR it took me over a year to walk without a limp but now I can move freely and am doing great. Keep looking - there are surgeons who will help you even if you are overweight.

Buffalo, NY

#26 Jul 9, 2014
There is a thread on bonesmart.com in which an obese women was complaining that her doctor would not do a hip replacement unless she lost weight. One of the self-appointed experts on the forum told her to search for another doctor, and one poster suggested picketing her HMO for refusing to operate on her in her obese condition.

What she needed to hear was to lose weight and suggestions about how to go about it, but instead all she got was "support" for remaining obese, clearly proving that people who are fearful of hurting another person's feelings with good advice ought not to be dispensing any advice.

Brooklyn, NY

#27 Jul 9, 2014
That is great, Auntie Moo. So glad your hip surgery was a success.
I will recommend bonesmart.org to everyone I know. So many people I know - work, church, life - are needing hip or knee replaced.

Buffalo, NY

#31 Jul 9, 2014
It's outrageous that someone involved in the healthcare would be encouraging someone who is overweight to ignore medical advice to lose weight and instead seek a doctor who will ignore their weight issue. Especially those who have arthritis.

Excess body fat is one of the worst enemies of someone suffering from arthritis. Encouraging an obese person to avoid losing weight by seeking a doctor willing to do whatever the patient will pay for is particularly cruel. Bonesmart should be ashamed of itself if it condones such behavior on their website.
the Arthritis Foundation wrote:
How Fat Affects Arthritis

Being overweight can make arthritis, gout, lupus, fibromyalgia and other joint diseases and conditions worse

obesity in some cases raises the risk of getting a certain type of arthritis; in all cases, obesity makes arthritis worse. One in 5 Americans has been diagnosed with arthritis, but according to the Centers for Disease Control and Prevention (CDC), that number jumps to more than 1 in 3 among obese people.

But it’s not just the extra weight on joints that’s causing damage. The fat itself is active tissue that creates and releases chemicals, many of which promote inflammation.

“These chemicals can influence the development of OA,” explains Jeffrey N. Katz, MD, a professor of medicine and orthopaedic surgery at Harvard Medical School and Brigham and Women’s Hospital in Boston.

This effect can be seen in the numerous studies that have linked extra weight to hand OA.“Obviously, you don’t walk on your hands, so there may be something that is produced by fat cells in the body that causes the joint to break down more rapidly than it might otherwise,” says David Felson, MD, a professor of medicine and epidemiology at Boston University School of Medicine.

For both reasons – excess joint stress and inflammatory chemicals – fat should be kept in check among all people, especially those who already have OA.

Brooklyn, NY

#32 Jul 9, 2014
Nogods, you seem very angry and self-righteous; fixated and obsessed with weight, this bonesmart organization, your notions about recovery, etc. Like most, you must be bored and have a lot of free time on your hands while recovering from your surgery. You should practice walking with your walker and doing your PT exercises and get some fresh air. Maybe read a book you've always wanted to read, or watch a movie or two. These will make you feel better than posting repetitively on the internet and lecturing people over and over again. You call yourself 'no gods,' but frankly with your repeated comments you come across as someone with a god complex whose mission is to make people believe in your beliefs about these various matters. What do YOU care if someone is overweight or not, or which websites they wish to read?

Buffalo, NY

#33 Jul 9, 2014
Tam, you confuse factual information with anger. If some supposed health oriented forum suggested that smoking cigarettes was not harmful would you think anyone who exposed their BS was angry?

Posting factual information that disputes the BS one finds on bonesmart is'n't anger, it's just facts.

Your immature attempt to attack the messenger because you don't like the message might be persuasive on a closed forum like bonesmart where they can dumb down the audience by controlling the participants, but in the open forums of the net it won't hold water.
Dr Tom

Buffalo, NY

#34 Jul 9, 2014
Tam wrote:
What do YOU care if someone is overweight or not, or which websites they wish to read?
What do any of us care who reads what. But when people are parading as experts and giving harmful advice, then maybe it is time for others to be concerned about what is being said.

I took a look at bonesmart. The community over there did in fact encourage a member to look for a doctor who would replace her hip despite her obesity after her existing doctor told her to lose 30 lbs first. And a member did say he would picket the HMO of her existing doctor because he wouldn't operate on her until she lost weight.

Given such poor advice being bantered about on bonesmart, how could anyone trust anything else on that particular website?

Do an internet search for "The tough love message some morbidly obese people need to hear." Now imagine the horrible consequences for Brian Flemming if he had landed in a bonesmart like forum instead of encountering Jackie Eastham. Instead of hearing what he needed to hear, someone would have told him to just get a bigger couch.

The bottom line is that we don't have to care what other people read, but we should care about the poor advise being given to people in need.

If you have something to say in defense of their position then have at it. But Nogods is right about your childish attack of him simply because you don't like what he had to say.

United States

#35 Jul 9, 2014
Dr Tom, are you Nogod's?

Buffalo, NY

#36 Jul 9, 2014
Not only does obesity increase the risk of complications and negative result from hip replacement, it also appears to a major reason for OA inn the first place, as shown by this study
The American Journal of Medicine wrote:


We studied whether several modifiable factors were associated with the risk of total hip replacement due to hip osteoarthritis among women.


Higher body mass index was associated with an increased risk of hip replacement due to osteoarthritis (P for trend = 0.0001). Compared with women in the lowest category of body mass index (<22 kg/m2), those in the highest category of body mass index (&#8805;35 kg/m2) had a twofold increased risk (95% confidence interval [CI]: 1.4 to 2.8), whereas those in the highest category of body mass index at age 18 years had more than a fivefold increased risk (95% CI: 2.5 to 10.7). Age also had a positive association; women aged &#8805;70 years were nine times more likely to have hip replacement than those aged <55 years (95% CI: 5.4 to 13.9). Recreational physical activity, smoking, alcohol use, and postmenopausal hormone use were not associated with an increased risk of hip replacement.


In the Nurses’ Health Study, higher body mass index and older age significantly increased the risk of total hip replacement due to osteoarthritis. Part of this risk appeared to be established early in life
Dr Tom

Baltimore, MD

#38 Jul 9, 2014
Syl wrote:
Dr Tom, are you Nogod's?
No I'm am not. What an odd question.

United States

#42 Jul 11, 2014
No I am not. And it is really none of your business anyway.

Columbia, SC

#43 Jul 11, 2014
Tcousins, are you Syl?

Newport Beach, CA

#44 Jul 12, 2014
Go to any rehab facility and the people you will see struggling the most are the overweight ones. The wince, they cry, and they quite early more than any other group of people undergoing rehab.

Why would anyone subject themselves to a total hip or knee replacement without preparing their body for the best possible outcome?

Anyone with just a Holiday Inn knowledge of medicine would know better than to encourage a person to ignore a doctor's advice to lose weight. If your doctor says you are too overweight for a hip replacement, then find another doctor so you can eat another fast food burger and not have to get of the couch is a prescription for failure.

Since: Jul 14

London, UK

#45 Jul 13, 2014
Weight should never be a factor in deciding whether a person should have hip replacement surgery. Doctors don't know everything.

New York, NY

#46 Jul 13, 2014
Good point, JosephineB.

Newark, NJ

#48 Jul 13, 2014
I'm a BBW. I had three doctors tell me they would not do a hip replacement on me unless I lost at least 50 lbs. I finally found a doctor who was willing to do my hip replacement. It will be done next week.

I was on the tour of the hospital last week. I noticed that the toilet seats in the rooms all have handles on them that are way to narrow for me. I asked the hospital administrator about the narrow seat handles. She told me I would probably have a catheter and use a bed pan because they don't have any wider seat handles.

I also did not see any wide walkers in the Physical Therapy room. All the walkers I saw were also too narrow for me.

I am now thinking that maybe I should cancel the operation to try to lose some weight first. I'm afraid they'll send me to a rehab center from the hospital where I'll run into the same issues.

Since: Jul 14

Baltimore, MD

#50 Jul 14, 2014
Nancy, I think you should have listened to your first 3 doctors, but unless you feel certain that you will lose that weight, you might as well go forward with the surgery if you have confidence in your existing surgeon.

At the very least, you will get relief from the pain. Putting off the surgery won't help if you don't lose the weight, and although statistics show most obese patients do not lose weight after surgery, some do. Hopefully you'll be one of the patients who does lose weight after surgery.

Buffalo, NY

#51 Jul 15, 2014
Now imagine how embarrassing this would be if it was one of those toilet seat rises on legs that you place over the toilet


Since: Dec 13

Oakland, CA

#52 Jul 16, 2014
Nogods wrote:
Note that in each of my post on the topic I quoted published scientific studies along with the name of the organisation that did the study or published it.
Tam didn't respond to any of the factual information. Instead she tried to avoid the facts with an inane personal attack.
Is that how they do it on bonesmart?
Bonesmart won't even let you argue your point, whether you have factual references or not. If you post one dissenting comment, it will be edited by their moderators, or sometimes the post is removed entirely!! They do not tolerate other points of view. It is a very closely monitored and suppressed forum.

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