Orthopedic Surgeons do not possess the tools or the clinical skills needed to guide patients in the treatment of obesity. I am a knee specialist in Scottsdale, Arizona and I face this dilemma daily. The Hippocratic Oath instructs physicians to “do no harm” to the people we treat.
Morbid Obesity, defined as a BMI (body mass index) of greater than 40, is a proven risk factor for adverse events before, during and after orthopedic surgery. There is an increased likelihood of knee infections, blood clots, wound healing problems, reoperation and readmission to the hospital. There are specific anesthesia risks such as vascular access (harder IV placement), accurate vital sign monitoring (usually need arterial line), harder breathing tube placement, difficulty getting oxygen into the lungs, and problems with safe positioning on operating room tables. Finally, there is a greater chance for serious heart and lung problems during and in the days following surgery. Patients with normalized body weight are more likely to have an uneventful surgery free of complications. For the stated reasons, I embrace the Hippocratic Oath and avoid joint replacement surgery in my patients with morbid obesity.
The paradox is apparent - we, the medical community, are not smart enough to help our patients afflicted with obesity to overcome their disease. Sadly, modern medicine does not have a predictable treatment for obesity.
Orthopedic Surgeons do not possess the tools or clinical skills needed to guide patients in the treatment of obesity. Race, ethnicity and gender contribute to the obesity epidemic in poorly understood ways. Cultural differences between blacks, caucasians and latinos need to be better defined for treatment programs to be successful.
In America there is a lack of knowledge as to how to best incorporate a variety of medical and non medical specialists to combat obesity. There is no network of treatment resources to address the multitude of obstacles obese patients require to treat malnutrition and psychological disease (anxiety/depression). For some, socioeconomic inequalities such as lack of healthy food marketplaces and lack of public places to safely exercise propagate the problem.
Obese patients know they have a life threatening disease. Obese patients do not want to be heavy. America must come together to find answers to treat our sickest citizens. The answer lies in finding ways to alter cultures, environments, economics, and education. We have to do better. Neglect is not a treatment plan. Knee arthritis surgery is not the first step in the treatment plan for curing obesity because it is not safe to perform major surgical procedures on our morbidly obese patients - the health risk is too great.
I believe the orthopedic surgeon should optimize patient function with mobility assist devices such as bracing, canes, walkers, scooters and Segway's. We will manage pain with oral and topical medications, knee injections, and low impact land and water based exercise. As always we will provide our patients with clear rational, reasoning as the basis for our recommendations and treatments.
Orthopedic surgeons need help from our medical colleagues. Patients will need treatment of the emotional component of their disease. We suggest the patient explore culturally specific guidance. Some of our patients need guidance with shopping and eating healthier. It is the duty of health professionals to mandate exercise.
Lastly, as physicians, we offer support, encouragement and guidance. Our American system has to do better - Our Patients Need Help.