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Jim Carrey is a goof.
I'm an opportunistic fan of his- if I come across a viewing of one of his movies, I will watch and render a few laughs, sometimes a chuckle, sometimes unrestrained, and other times I can laugh and push the limits of continence (notable coming from a male). There can be long expanses in his productions that it seems I am just waiting for the next laugh, other instances that i am in comedic rapture. Just my opinion-
So, why the reference? One scene I remember from Ace Ventura When Nature Calls, is the fight scene. Ace as the "White Devil", is a target for the Woochachu (phonetic spelling) Warrior that throws a spear and it hits its mark, in Carrey's leg. Then another direct hit, in the other leg. The motion he makes as he emphasizes the arrows in his leg always makes me roll, and then he goes one step further, as if it's necessary, to explain why it is so painful..."It's in the Bone!!" and dances around holding each of the arrows to try and relieve the pain.
If you saw the movie, I am sure you remember the scene. If not, sorry; guess you had to be there.
Lastly still, maybe you were there and didn't find it funny (like my wife, if I remember correctly), and then I just offer condolences for wasting so much of your time getting to topic....
Orthopedics and Bariatric Surgery - A New Union?
Total joint replacements of the weight bearing joints are on the rise, both in number and on younger patients than ever. Up a reported 165% in the past two years, according to JAMA.
The main reason for the procedures, of course, is pain and limited ROM. And, with the obesity epidemic we are experiencing, irreversible degenerative joint disease is a direct byproduct of that environmental condition.
A interesting study was done recently in Canada that followed 125 obese knee replacement-candidates, who had to lose 10% of their body weight before they had surgery. In the yet to be published study, about half of the patients dropped out of the study, and opted not to have their total joint surgery as they were symptomatically much better off.
It is known that six to eight times your body weight is borne through the knee, so for every 10 pounds lost, roughly 60-80 pounds less pressure is experienced situationally and therefore additively diminished over time. Obviously if the DJD is present / advanced enough, the Xray won't change, but the symptoms likely will. And still further, without significant weight loss that may come from surgical or medical means, destructive joint forces continue to increase over time, with resultant progressive increase in pain and immobility. The boney changes to the joint are not reversible, and the cartilage is a finite entity as a cushion in the joint- once it's gone it's gone. No way to replace that.
In effect, weight loss is weight loss, as far as the joints are concerned, and the quicker it comes off - maybe even just 10% to start to make a demonstrable difference- as well as the more significantly it comes off, and stays off, the better for the skeletal system.
I have seen numerous patients in the office over the past few years that have had bariatric surgery, or are in process to have it, who have in essence been referred by their orthopedic surgeon as a safer / expedient way to get to their total joint replacement to treat their irreversible and very symptomatic DJD.
The benefits of substantial weight loss before total joint surgery are multiple: safer for the patient, less post op complications, easier airway management, better wound management, easier PT / Rehab post-surgery, reduced risk of DVT, and less risk of hardware needing to be replaced prematurely. This is my own and likely partial list, mostly common-sense, but not taken from any specific study.
The downside? Maybe less surgeries for our local orthopedists, but I think they would all agree that total joint surgery is a good surgery if necessary, but avoiding or postponing it in a patient with obesity is quite uniformly a good thing.
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