Hip replacement and BMI.

[JohnTheRevelator]

Has anyone on here had a hip replacement when their BMI has been in the overweight/obese category? I am on the waiting list to have a hip replacement and at the moment my BMI is 32. A couple of years ago it was 44,but I've managed to lose 7 stone. I'm trying to lose another 3 stone at the moment. A few people have told me that it wouldn't be a barrier to having a hip replacement,but several things that I have read indicate otherwise. I'd hate to miss out on the op because my BMI is too high.

My mum's recently had one and she's overweight

@mynamechangemyrules, @Skipsy, I've been referred for bilateral high tibial osteomeomy, to hopefully hold off on full knee replacements for 10 more years. The surgeons i saw was adamant no one in this area would perform a full knee replacements on someone of my age. It's frustrating as I've been on crutches for 10 years now and have just had to give in and get a mobility scooter and wheelchair as I can't even walk from my lounge to kitchen without severe pain. Definately a postcode lottery but I understand that tkr revision surgery has poorer outcomes, but my life is so restricted due to my mobility and pain. Oh well it is what it is

If you are already on a waiting list, you meet the criteria. Otherwise they would have discharged a referral.

As a Director of Clinical Services deciding if we can progress a patient to hip surgery is my daily job. standard to accept up to. BMI 40. If there are significant co-morbidities then it’s 35. We also don’t accept <18. No reason to think you won’t be in ok

I'm in awe of your weight loss, brilliant!! Good luck with the hip surgery, my brother has had a double hip replacement in his early 50's and feels so much better - good luck!

I'm due to have gynae surgery and they won't operate over BMI 40

I do have other conditions 😒 Hypertension,which is successfully treated with medication,also I had a pulmonary embolism 7 years ago,so I'm now on blood thinners for life. I hope these won't affect any decision!

Thank you so much to everyone who has responded! I'm feeling very encouraged and reassured now. I didn't actually realize that because I am actually on the waiting list,I meet the criteria!

If the surgeon has put you on the waiting list then they've agree to go ahead with surgery

The anaesthetist can sometimes turn around and say BMI is too high to safely anaesthetise someone, but 32 will be fine.

My best friend is having hip replacement on Monday. She had to lose a lot to be eligible. They said it was because of the anesthesia.

We do have final say. Noone can make me anaesthetise someone. But bmi of 32 is pretty small by modern standards

@Destiny123 stupid question but if you're the final decision would you go off BMI or appearance/clothes size?

For instance someone with a BMI of 37 but they're 5ft 10 and a size 16 (so solid looking but not what you would think BMI wise)

maybe i'm just a bit soft in my old age, but where I work the decision to proceed or not is more usually a multidisciplinary one that involves the surgeon and the patient as well as the anaesthetist...think 'shared decision making' is the buzz term. But yes, a whole list of patients with a BMI of 32 would be an absolute treat.

Congratulations on your weight loss!
That is a massive achievement even more so considering you have a damaged
They can even give a spinal block for hip replacement now, if for example a patient is frail or too complicated for GA

Well yeah, it's totally mdt driven for elective surgery, we see in clinic do our total best to optimise and fix what we can, discuss with surgeons about how urgent something is, can we delay to get them in a safer state etc etc etc (as we don't truly know how urgent surgery is, that's a surgical decision and we facilitate as best we can)... but at the end of the day I'm not going to have my arm twisted to anaesthetise someone I feel isn't safe to do so

I dont think ive ever cancelled someone on bmi alone, it tends to be the long list of associated comorbidities that come with obesity that causes us to delay surgery for optimisation. Its all a risk benefit decision at the end of the day - we anaesthetise bmis of 60+ for bariatric surgery after all

The default for hips and knee replacements is spinal for all (+sedation if the patient wants it). Very few get GAs for them (only if certain medical conditions would make a spinal unsafe really). Think I've done 1 GA in maybe 8y for a hip or knee

That’s surprising to hear. I had a GA for a hip replacement 8 years ago when I was only 50and didn’t have any other medical conditions 🤷🏼‍♀️

Did you have an injection in your back 1st? As tbh from a patient perspective sedation/GA is synonymous.

Even my mums hips were spinal/sedation 26y ago so it's not a new thing (far better recovery pain relief and lower side effects

I was told it was a GA and I was "out" for many hours and disorientated when I woke up so I believe it was a GA.

I've had sedation for a tooth extraction before and that felt very different.

I had mine last year and didn’t have a GA. I think that’s standard?

Thinking about it, I did have the operation in a private hospital and it's possible I was able to choose which anaesthetic I had.

I would have gone for a GA due to a previous bad experience with an epidural so possibly that is why I had a GA when most hip ops are done with an epidural in recent years it seems.

Spinal anaesthesia has been very much the norm for years and years now (way before I qualified 20 years ago) unless there are medical contraindications or a patient insists on a GA (or occasionally, if we can't get a spinal in then GA is the remaining option). Usually if a patient declines a spinal it's from a point of fear of the unknown/misunderstanding or sometimes confusing spinals with epidurals (they're completely different techniques). For lots of big orthopaedic operations though spinals often give better immediate post op pain relief, less nausea, earlier mobilisation, slightly lower chance of DVT, and they can be better in terms of post op cognitive function (even better if it's just a spinal with no sedation, although for hips more than knees people often do want a smidge of G&T level sedation because lying on one side for an hour can get a bit uncomfortable). If a spinal isn't possible then there are other additional things that can be done in combination with a GA (nerve blocks) to improve pain relief, but often GA customers do end up needing more systemic opioids (eg morphine) and that can leave you feeling a bit more naff for a while afterwards.

Sedation thst dentists are allowed to use is nothing like sedation from an anaesthetist... our drugs are way better. Its the drug for a ga as sedation when we give it

No hip or knee is done by epidural. They're all spinals. Similar but different, next door space through a layer of cling film in the back. Far more reliable, epidurals have a 10% failure rates, spinals have incredibly rare to not work