EUROPEAN ORTHOPAEDIC RESEARCH SOCIETY

 

Smart and Sensible Weight Loss For Total Knee Replacement 

If you need knee or hip replacement, and you are overweight, your doctor may advise that you lose weight first, before the operation. In fact, if you lose 25 lbs, you may not need surgery at all.

Doctor: I would like to introduce to you, Jeniffer, a new patient for us.

Jennifer: Yes.

Doctor: And this is the first day you've been here. And you told me such a very interesting story that I asked if you would please tell other people or other patients. Because I think you can help them, because I think you've got a secret, and am gonna ask you a little bit about that secret because I think it is very beneficial.

Where am I going on this is weight loss. And one very important fact is, if you've a knee injury or a knee arthritis you are going to gain 20 to 30 pounds, and maybe even more. And it's because you obviously have decreased your activity you therefore your body burns fewer calories, and so you start putting the weight on. And then I think in our society, in America I think, we all tend to eat and maybe eat a little bit more, and not exercise, enough. So it is a very significant problem.

And then the second fact that I mentioned to you, is for every pound extra you weigh, you put four pounds on your knee joint, and when you climb stairs it is six to seven pounds. So if you already have gained 20 pounds you literally, are putting eighty to hundred pounds, and those are real pounds, if you've tried to lift 50 to 80 pounds.  Those are real pounds.

Now Jennifer, you have a right knee injury and you do have arthritis (and she had an arthroscope a few months back and it does show that she has major areas of loss of cartilage), and we did review that with you today.

Jennifer: Yes!

Doctor: And the second fact that you are interesting is that you are 40 years of age and you are told that you had to kind of live with your problem.  And your problem, how far can you walk before you have pain?

Jennifer: From the car to the door!And that's not something that's very nice to live with. No not at all.

Doctor: And you are 40 and so you have pain really with every activity, don't you.

Jennifer: Yes yes I do, am swollen.

Doctor: That's why you are here. And how did you feel when they said there is nothing we can do for you, and that you are going to have to live with that?

Jennifer: Not great, very frustrated, but still I felt like there was something that can be done.

Doctor: And you've had some family members who have had knee replacement.

Jennifer: Yes and its been very successful.

Doctor: And its doing very well?

Jennifer: Yes.

Doctor: And the question you would ask is: if it works very well for someone at their 70s, why can't it do very well for someone in their 40s. And the answer to that I told you is that's absolutely correct. And now knee replacements are so successful that we do them at much younger age. But I also told you everything has to be perfect.  Because we don't want to have a chance so we going to have to go back in the due surgery as at in earlier times.

So modern knee replacements are 90% still done at 20 years so and we expect they'll last much longer. But the one thing that must be right is weight. And do you mind telling us how much weight you've lost since June 19th when you started your plan?

Jennifer: I've lost 52 pounds.

D: And you haven't been able to exercise?

J: I haven't been able to exercise.

D: And how did you magically do that? And you said you did some research?

J: I did. I obviously gained quite a bit of weight and was not able to exercise. So I just started doing some research on different foods, and carbohydrates and sugar and fats and I found that a lot of times people are having success with a low carb and low sugar diet."

D: And that I said is absolutely right. So you essentially knocked out all sugars and carbohydrates?

J: Exactly yeah! Very few carbs. I have limited myself to 20g carbohydrates and 10g of sugar.

D: And you stayed a little higher on proteins?

J: I do a lot higher on the protein side, which is good because if you eat a lot of proteins it does make you feel fuller, you are not in binge eating or anything like that. But once you've started, I mean if you can get through the first two weeks, you know, I was home free.


D: And tell me, what you thought on the first two weeks, the trouble you had staying on the first couple of weeks.

J: Well, the first couple of weeks were hard, because it's like putting your body through detox. Your body is used to getting all the sugar and carbohydrates, and when you completely cut that out or lower it to the amount that I did, it was a like wanting to withdraw. I had a lot of headache. You know, because you feel like you are just starving your body, but you are not! You are retraining it. And after about two weeks, I didn't have any more headache, I was getting used to it. And I decided that I would not check my weight until once a month. So the third month, I realized this is working, I've dropped some weight, lets see how this goes.

D: Lets see how far you can go. And the craving, how's the food craving now?

J: Actually I don't crave, pasta, potatoes ,bread, sugar,cake, candy, I don't even crave it anymore.

D: That's amazing, that's the secret though. That's the amazing story. So I asked you just to give example of the food. You have a very light breakfast?

J: Right I have, prior, like a protein bar, low carb protein bar.

[Editor's note: A clinically proven program to lose weight safely is Nutrisystem. Read how it works. Similarly, BistroMD weight loss program by bariatric physician Dr Cederquist is a great option.]

D: And I kind of kidded you, I said you didn't have all the potatoes, and cereals and other things.

J: No not at all.

D: But then at lunch time, do you have some protein?

J: Yes I have, eaten sometimes, another protein bar, I ate eggs, I can introduce some scramble or an omelet. If you did research you can see that you can add peppers and things like that to make it more interesting for you, the best of your sauces can do.

D: And vegetables and fruits?

J: Probably, real chicken, eaten some red meat because of low carbs.

D: So at lunch time you can treat yourself a little bit more?

J: Right, so you know I eat that, and cheese. You know you can have all the cheese and butter if you want, you know they are good fats.

D: They are good fats, we tell people to be careful with all that also, to keep that in moderation

J: Yea absolutely. And after the first couple of months I also read that it is good, sometimes, to give yourself a cheap day and just kind of eat whatever you want. And that's good because it kind of re-kicks your metabolism, restart it, so you don't just plateau, you know when your body gets too used to it. So its actually very effective to have a day where you can eat whatever you want. But for me, I'm even still conscious, conscious about it.

D: Well that's really a good secret. And one thing we would add to that is, we have had our therapist say that some sort of physical activity and, even if you can't be on a treadmill, he thinks you could do upper body exercise and you can do yoga, you can do exercises on the floor. So there's a lot of things we can do. So I think that's really an amazing story.

J: Thank you!

D: And I appreciate, Jennifer, you are telling us that story, because so many times patients want to do better and you've decided that, that was just something you could do. And you are your own internal coach. Aren't you?

J: Yeah!

D: You have to have that will power. To do it.  I mean its your choice you know, even going out to a restaurant, you have a choice to eat that bread or not, I don't.

J: That's great!

D: Well that's a great story. And the answer to that is that Jennifer is now in a position where she continues to lose weight and we are not going to do the knee replacement immediately. We are gonna look for that weight to come down a little bit more.

J: But then we are going to set a number, and have her totally hit that point, and then she can eventually lose another 15-20 pounds and come down to entirely normal Body Mass Index.

D: And then you can really restart your life and have a better knee.

J: I look forward to it!

D: Good! Is there anything you wanna say about our interview or what's going on here today?

J: No, I have been thoroughly impressed with everyone having treated me, how you've treated me, and have been very honest. I'm looking forward to working with you and anybody else in the rehab and push this establishment.


 

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