Dr. Elkins in a consultation with a patient

Bariatric Joint Replacement

We make it possible for people with chronic hip or knee pain—and a BMI greater than 40—to have joint replacement surgery.
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Have you been told you can’t have joint replacement surgery because your body mass index (BMI) is too high? If so, you’re not alone.  

If you live with obesity, you’re much more likely to develop hip pain or knee pain that requires surgical treatment. However, many surgeons choose not to perform hip or knee replacement surgery on people whose BMI is greater than 40. That’s because a high BMI is associated with a higher risk of surgical complications.  

Fortunately, you may still have options with University of Iowa Health Care.  

Our orthopedic surgeons believe your eligibility for joint replacement shouldn’t be based on your BMI alone. We take a unique approach that’s based on your body composition instead of your total weight. In other words, we look at the percentages of muscle, fat, and other elements that make up your body weight. 

We now have options for patients who are close to meeting surgical weight goals. Patients between 40 and 55 BMI who otherwise meet surgical criteria may qualify for the bariatric joint arthroplasty clinic. We’ll help you set goals that could make it possible for you to have surgery—and live without chronic pain. 

Becoming eligible for joint replacement surgery

If you have joint pain and a BMI over 40, you’re probably in a cycle that’s hard to break. You may have been told you need to lose weight before you can have a hip or knee replacement. But your pain makes it hard to exercise.  

UI Health Care’s orthopedic experts understand how frustrating this can be. That’s why we take a deeper look at your musculoskeletal health instead of making decisions based solely on your weight.

Our evaluation process

To assess your candidacy for joint replacement surgery, we take several simple measurements. These include your: 

  • Muscle mass: Adequate muscle mass is a sign of physical health—and indicates your body may be strong enough to undergo surgery. If your muscle mass is healthy, you may be a candidate for joint replacement. This is true regardless of your BMI.  
  • Body fat percentage: We’ll measure how much of your weight is comprised of a type of body fat called adipose tissue. Having extra adipose tissue slows blood circulation. This makes it harder for your surgical wound to heal and for your body to fight infection. 
  • Fluid levels: If extra fluid builds up in your body, you may develop swelling in your upper or lower extremities (known as edema). Untreated edema can also slow your blood circulation and increase your risk of problems like infection and skin ulcers. 

If your results aren’t within a healthy range, you’re not yet ready for surgery. But we’ll help you improve them.  

For example, if you need to build muscle, we can teach you how to increase your protein intake. We’ll also recommend strengthening exercises that are less likely to aggravate your hip or knee pain. 

We’ll monitor your progress and repeat your measurements until we’re confident that you’re healthy enough for surgery. 

Additional criteria

In order to have hip or knee replacement surgery, you also need to meet the following criteria: 

  • You must be mobile (not dependent on a wheelchair to get around) 
  • You must be nicotine-free (smoking reduces blood flow, which slows healing and increases your risk of infection) 
  • You must be previously diagnosed with osteoarthritis 
  • If you have diabetes, it must be well-controlled (your hemoglobin A1C level should be less than 7.5) 

What to expect

It takes about 3-6 months for our patients to reach their goals and become eligible for joint replacement surgery. 

Here’s what you can expect during this process: 

Your initial consultation

During your first visit, you’ll meet with an orthopedic surgeon who specializes in joint replacement for people with obesity. Your appointment will include: 

  • A medical history review: We want to understand how your joint pain affects your daily life. We’ll go over any challenges you’ve faced while trying to achieve a healthy weight. And we’ll discuss whether you have other medical conditions that could impact your ability to have surgery. 
  • A physical exam: We’ll evaluate the strength, flexibility, and range of motion of your painful joint. 
  • Functional muscle strength: We’ll perform simple tests to determine your ability to perform everyday tasks without pain, stiffness, or restriction. 
  • Body composition measurement: We use a noninvasive device to evaluate your body composition. You’ll step on a small platform resembling a scale, placing both hands on an attached set of handlebars. The device calculates your muscle mass, body fat, and fluid levels by sending painless electrical currents through your body. 

The body composition test takes less than a minute. And you’ll receive your results immediately.

Your personalized plan

The data provided by your body composition test helps us set targets that you’ll work toward.  

We won’t give you a traditional goal weight with a specific number of pounds to lose. Instead, we’ll create a plan to help you build muscle, lower your body fat percentage, and/or reduce edema. Your plan will include both diet and exercise recommendations. We may also refer you to other specialists who can help you reach your goals. 

Once you hit your targets, we’ll schedule your hip or knee replacement—even if your BMI is still over 40. That’s because with our approach, your overall weight may not change. For example, you might lose 10 pounds of unhealthy body fat and gain 10 pounds of healthy muscle mass. 

Follow-up visits

You’ll meet with our specialized nurse clinician about three months after your initial consultation to review how you are coming along with your goals.  

At this visit, we’ll check your progress by repeating your body composition measurements. Then we’ll decide whether you should continue with your diet and exercise plan or move forward with surgery.  

Our Care Team

Jacob M. Elkins, MD, PhD portrait

Jacob M.
Elkins
MD, PhD

  • Orthopedics and Rehabilitation
4.73 out of 5 (1,307 ratings)
Natalie Hays, MPAS, PA-C portrait

Natalie
Hays
MPAS, PA-C

  • Orthopedics and Rehabilitation
4.77 out of 5 (972 ratings)
Olivia R. Johnson, MPAS, PA-C, RD portrait

Olivia R.
Johnson
MPAS, PA-C, RD

  • Orthopedics and Rehabilitation
4.79 out of 5 (492 ratings)

Want to get rid of your joint pain for good?

If you need a hip or knee replacement but were told your BMI is too high for surgery, call us. Our orthopedic surgeons have helped many people with a BMI greater than 40 become eligible for joint replacement surgery.
Call 1-319-356-2223 Call 1-319-356-2223

Locations and Offices

Orthopedic Clinic Floor 4
Elevator A, 4th Floor
1-319-356-2223
Clinic
MCNL Ortho Clinic 4th floor
In Medical Center North Liberty
701 W. Forevergreen Road, North Liberty, IA 52317
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