A dilemma for patients as well as clinicians!
Let us consider both the cases:
1. Knee replacement before weight loss surgery
a) The knee pain would be resolved, and the patient will be able to walk without pain.
b) The benefits of walking as an exercise may be added, but post-operative physiotherapy is so difficult because of the huge excess weight at times.
c) There would be higher risks during anaesthesia due to the comorbidities, surgery may be more difficult due to the excess fat deposition around the knees and thighs. Special care may be needed to minimize wound infection or delayed healing since fat has poor healing properties.
d) The associated conditions in these patients like diabetes, blood pressure, breathing difficulty add to the difficulties before and after the joint replacement.
2. Weight loss surgery or bariatric surgery before the joint and knee replacement
a) Weight loss surgery adds distinct benefits like weight loss, reversal or control of diabetes, blood pressure and breathlessness.
b) Patient’s pain also reduces significantly because of the weight loss and less pressure on joints. In many patients, the pain totally disappears, and knee replacement can be deferred.
c) Post knee and joint surgery their movements on recommended physiotherapy exercises also turns easy
However, if a joint replacement is performed after the bariatric and obesity surgery, the surgery is easier and diabetes control reduces the chances of infection.