Is hip/knee replacement or ankle surgery cost effective on people chronically overweight?

I have a friend who was told by her doctor that he won’t operate on her knee until she loses weight.

I’ve heard the same thing from doctors and from friends who’ve had such surgery. I’ve needed knee surgery for a very long time and just this year lost more than 15 pounds in preparation. I dread having to go under the knife and even more so, the lengthy rehab, but the clock is ticking.

About 7 years ago I was hospitalized (non-weight related health issue) and I was on the same physical rehab floor as some people who just had weight loss surgery and who were hospitalized to help them transition and recover. I can assure you that the rehab alone for these extremely obese people costs extra. I am not referring to people who were 200 or 300 lbs. I am referring to people who were 400 lbs and over. They require extra staff to help them transition to extra wide wheelchairs, hydraulic lifts to get them off the toilet, extra heavy-duty hospital beds. It makes sense, to me, to deal with their weight issues first before joint replacement. @Pachy: 15 lbs is a wonderful achievement but I don’t think a doctor would refuse joint replacement surgery for that minor amount of extra weight. I think the OP was referring to heavier people than that.

No

When my husband injured his knee he was only mildly overweight. Due to his decreased mobility from the injury he became obese. Once he got his knee replacement he became active again and was motivated to lose the weight. I don’t think that ever would have happened if he still had the pain from his bad knee. He was in his mid 50’s at the time and his hick surgeon who botched the surgery after his injury refused t do a replacement because he was to young. (thank God, otherwise we wouldn’t have found the guy who invented the minimally invasive knee replacement!)
He is now almost 65, just had a check up and his knee is as good as new. He is really active and has very little pain.

Nice @Judi.

For any hip/knee/ankle surgery candidates, the lighter weight the patient is, the better will be the ultimate outcome of the surgery. Certainly, for anyone carrying too much excess weight (i.e., 100 – 150 pounds over ideal body weight or more), that really should be addressed and resolved first.

I’m not sure exactly what you were driving at when you asked about “cost effectiveness”. It seems to me that “cost effectiveness” is not a goal of medicine. (Except that engineers, inventors and anyone involved with the development of new technology and procedures is always interested in reducing expense, recovery time, complications of the procedure, etc.) The purpose of medicine and all of health care is to “alleviate suffering”. Yes, as with all other human endeavors, cost plays a part (I’m not going to reduce all of human activity to “economics”, but I would say that economics is at least a part of all human activity).

If you meant “medically effective”, then I expect that there’s a certain element of that. If one’s obesity has resulted mostly from one’s inactivity, then the question could be asked: Why do you even need a new knee if you’re not going to use it and be more mobile? So, prove that you need the knee by using the one/s you have now; get up and walk more and lose the weight so that the new knee won’t be “wasted” on an immobile recipient. However in some cases it may be that the pain of using the existing knee has led to the patient’s immobility, in which case the doctor shouldn’t be making a judgment that “a new knee would be wasted on this fat layabout”, so I hope that doctors aren’t making that judgment routinely.

I think he meant if you replace the knee of an obese person, and they don’t lose the weight, you’ll be replacing knee after knee after knee.