Claudette Lajam, MD: Obesity's Effect on Hip & Knee Surgeries


How has the obesity epidemic in the US affect how orthopedic surgeons approach pre- and post-procedure care?

The tools and resources available in orthopedic care are in abundance compared to just decades ago, but the burden of growing patient obesity could practically negate such advances.

In an interview with MD Magazine®, Claudette Lajam, MD, an orthopedic surgeon with NYU Langone, explained exactly how obesity affects hip and knee reconstruction patients, and also highlights exactly how technological advances have made modern orthopedic procedures a more guaranteed success for the surgeon and patient.

MD Mag: Do orthopedic surgeons have to address patient issues related to the increased prevalence of obesity?

Lajam: Obesity is a tremendous issue in orthopedic care. As you can imagine, when you put a lot more weight across the joint, it wears out faster. The way our bodies are made, the muscles multiply the weight of the body, when you're talking about joint forces.

So in your knee, you can have as much as 6 times your body weight across that knee joint when you're doing certain activities. So obesity is a tremendous problem when you're talking about arthritis—not only for the degree of pathology that you see, but also pain. When you're heavier and putting more force across an arthritic joint, it's going to hurt more.

One of the things we have to deal with—and now, really pushing patients to do—is work as hard as they can to get their weight lower if they are obese. The other thing about obesity is that we're not talking about healthy obesity. We're talking about very unhealthy obesity. Many folks who are obese are fat, but they don't get good nutrition. They are eating bad food, they're not eating protein, their blood protein levels are typically low.

We call this a metabolic syndrome more than we call it obesity. You're having the impact of the added weight on the joints, and also poor overall soft tissue in the body. You have to deal with a few things before you have to move on to doing surgery on these folks, because you want them to do well after surgery. If they aren't healthy, they're not going to do as well.

What advances have improved the current state of care?

Orthopedic surgery, especially joint replacement, has exploded over the past 30-40 years. It's almost amazing that the first joint replacements were done less than 50 years ago, and we have advanced so much in terms of the type of artificial joints we can offer people, the bearing surfaces and materials that we now have available to us, the tools we have available to us to put these pieces in the places we want them.

Like with navigation and robotics, we have a lot of tools we can use to help us not only serve more patients, but also put implants in a position that is optimal to allow them to last longer. Something done 35 years ago was done based on the surgeon's view and without as many tools. But now we have all these tools that help the surgeon make better decisions during surgery so the patient can have a better benefit from it.

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