01/29/2026
After caring for thousands of patients, obesity remains the most complex and difficult risk factor I face in joint replacement—not because of blame, but because of how deeply it affects pain, surgery, recovery, and expectations.
This is why I believe in slowing down and building a relationship with my patients.
Not rushing decisions.
Not using rigid rules alone.
But understanding the human being behind the diagnosis.
Here are 10 reasons why obesity makes joint replacement so challenging:
1️⃣ It is highly prevalent
More than half of the U.S. population is affected.
2️⃣ It contributes to arthritis and pain
Increased joint load accelerates cartilage wear.
3️⃣ It is psychological, not just physical
Behavioral, emotional, and social factors matter.
4️⃣ It is associated with worse outcomes after joint replacement
Including higher complication risks.
5️⃣ It is surgically demanding
Soft-tissue tension and exposure can make surgery more complex.
6️⃣ It is linked to higher complication rates
Infection, wound issues, blood clots, and stiffness.
7️⃣ Weight regain is common
Sustained weight loss is extremely difficult.
8️⃣ Pre-operative weight loss is often unrealistic
Severe joint pain limits mobility and exercise.
9️⃣ Surgeon decision-making varies widely
Some are overly restrictive; others overly permissive.
🔟 The benefit of weight loss before surgery remains controversial
The evidence is not always clear-cut.
My approach is not to judge or deny care—but to walk alongside patients, acknowledge the difficulty of obesity, and create a sensible, individualized plan that offers meaningful benefit.
Sometimes that means optimizing first.
Sometimes it means proceeding carefully.
Always, it means honesty and compassion.
⚠️ Educational content only. Not medical advice.
