Knee Replacements and Weight Gain How to Take off Extra Pounds After Joint Replacement Surgery

Your knee replacement’s complete. Now it’s time to work off the excess pounds you gained when post-surgical pain derailed your diet and exercise program. But resuming healthy weight habits after joint replacement surgery isn’t as easy as you might think. Here’s how to do it... For many knee replacement patients, surgery seems to be the key to resuming an active, vibrant life and a fitter body. The truth? Most patients actually gain weight following joint replacement surgery. Of 106 adults who had knee replacements, two-thirds gained an average 14 pounds within two years after the operation, according to a 2010 study at the University of Delaware. Post-surgery weight gain means trouble on several fronts. For example, it increases the risk of osteoarthritis in the non-operated knee. “For every pound gained, there’s 3 to 4 pounds of increased force on the knee joint,” which wears cartilage away faster, says study author Joseph Zeni, Jr., Ph.D., an assistant professor in the physical therapy department at the University of Delaware in Newark. Obese patients face other risks before and after joint replacement surgery. This includes “a higher risk of infection, blood clots and cardiovascular [problems] like heart attack and stroke,” says orthopedic surgeon Thomas Schmalzried, M.D., medical director of the Joint Replacement Institute at St. Vincent Medical Center in Los Angeles. But avoiding weight gain can be difficult, because successful knee replacements can take six months of rest and recovery. And restoring an exercise habit requires a new set of muscles, both physical and psychological. “Patients always say, ‘Now that my pain is gone, I’ll be able to return to walking and lose this weight,’” Zeni says. But a pain-free life doesn’t mean they’ll change their sedentary habits, he says. So how do you maintain a healthy weight after joint replacement surgery? Here are expert tips to keep pounds off and stay fit. 1. Track your activity. “Monitor what you do for a week and build your fitness goals from there,” Zeni advises. Create small, achievable goals, such as walking 100 extra steps daily. Track your progress with a pedometer (available online or in sporting-goods stores for as little as $15), daily journal or phone app. Phone apps Walkmeter (available for iPhone) and WalkMeter (for Android devices) use your smart phone’s GPS to record time location, distance, elevation, speed and calories burned. More expensive devices (starting around $100), wireless activity trackers that you wear, record your movements online; they include Fitbit, BodyBugg and BodyMedia. 2. Focus on your upper body. Upper-body exercises will keep your metabolism (the rate at which your body burns calories) up, even if recovery from joint replacement surgery makes it hard to walk, says Timothy J. Clark, a physical therapist and director of inpatient therapy at Nazareth Hospital in Philadelphia. Try this exercise with a resistance band (available online from about $10): 1. Wrap the band around a stable object, such as a sturdy porch, stair railing or secure structural column. 2. Sit facing the object, holding the band’s handles with your hands, arms out, palms down. 3. Pull your elbows back until they’re level with your body (as if you’re rowing), squeezing shoulder blades together and keeping your arms parallel to the ground. 4. Start with one set of 16 repetitions. Another simple exercise: Sit in a chair with arms, and push down on the arms with your hands, lifting up your torso. “That’s a demanding exercise that uses your shoulder muscles and those that extend to the elbow,” says Stanley F. Wainapel, M.D., a physiatrist (doctor of rehabilitation medicine) and clinical director of the rehabilitation medicine department at Montefiore Medical Center in New York. He also recommends an exercise bike for your arms. For about $50 online you can buy a Stamina InStride Cycle XL, which is worked by hand on a tabletop or on the floor by the feet. 3. Tuck exercise into every activity. You don’t need a gym or a trainer to work out, Wainapel says. Lift small weights while on the phone, walk around the room during TV commercials, and get up to chat with co-workers rather than sending an email. “I walk up the stairs and around my department all the time,” Wainapel says. “If you live in an apartment, walk your hallway several times a day.” Done often enough, small improvements are effective, Zeni notes. “Incremental changes add up; before you know it, you have a different lifestyle.” 4. Chill out. Ice your knees for 15-20 minutes after a workout to prevent pain and swelling, Clark advises. 5. Don’t go it alone. It’s much easier to stick with exercise and diets if you have support. “Ask your doctor for referrals to a nutritional counselor or behavioral therapist,” Zeni says. Or turn to a support group. “There were 600,000 knee replacements last year; there are a ton of people in the same situation as you who can share tips and strategies,” he says. You can find support groups through a local Arthritis Foundation chapter, YMCA or senior center. 6. Do workouts that you enjoy. Just because your best friend likes biking doesn’t mean it’s best for you. “Work with a physical therapist to develop an exercise plan you like and will be invested in,” Zeni advises. 7. Try thigh cuff weights. Your knees may not be ready for ankle weights following joint replacement surgery, but your thighs may be. (Ask your doctor to be sure.) Thigh cuff weights are available online starting at about $15. Strap the weights onto your thighs, “then flex your thighs up off the ground,” Wainapel says. “That’s a significant amount of exercise.” Start with 2 pounds on each thigh and try for 10 repetitions, he says. Check with your doctor before beginning a workout program and to find out when you can increase resistance levels in weight-training. 8. Take smart breaks. Rest while exercising can help build stamina. “Walk, rest and, in time, you’ll walk three blocks,” Wainapel says. 9. Get a nutrient bang for your calorie buck. Ditch muffins, pasta and other high-calorie foods that have little nutrition and won’t keep you feeling full for long, says Jason Machowsky, R.D., CSCS, a nutritionist and exercise physiologist at the Hospital for Special Surgery in New York City. Instead, eat lower-calorie fruits, vegetables and beans, which have more nutrients. The increased fluid and fiber help you stay full on fewer calories, and “your body needs the increased nutrients to meet the demands placed upon it by the surgery recovery process,” says Machowsky. 10. Switch to smaller plates. “Eating out of smaller bowls and plates naturally reduces the amount of food and calories we consume,” Machowsky says. In fact, when people were given a larger bowl, they served themselves 31% more ice cream than those who were given a smaller bowl, according to a 2006 Cornell University study. 11. Go slow. It takes 15 to 20 minutes for a person to feel full while eating, Machowsky says. So eat more slowly; it will prevent you from overeating, he says. 12. Chew more, eat less. When people chew 40 times instead of 15, they eat almost 12% less food, according to a 2011 study at Harbin Medical University in China, published in the American Journal of Clinical Nutrition. Obese patients tended to chew less often than thinner patients, the study also found. 13. Love water. Your body needs more fluids when recovering from joint replacement surgery, Machowsky says. So drink more water, seltzer water or unsweetened tea. If plain water’s not appealing, add a few slices of orange, lemon or lime. Water will also cut down on the amount you eat. “Sometimes we eat when we’re thirsty because our bodies [need] fluid,” Machowsky says. His pre-meal tip: Drink a glass of water and then eat 80% of your meal. Then consume another glass of water and wait 15 minutes. “If you’re still hungry, finish the meal,” he says. Drinking liquids with your meal also can aid digestion: “Water and other liquids help break down food so that your body can absorb the nutrients,” says Michael F. Picco, M.D., of the Mayo Clinic. 14. Reduce stress. Some knee replacement patients turn to food for solace when recovering from joint replacement surgery. “Instead, do stress-relieving activities like singing, playing the guitar or meditating,” Machowsky says. 15. Chew on gum, not food. You know those times when you just want to chew on something? Don’t reach for an oatmeal cookie. Instead, chew sugarless gum, which satisfies the need without adding calories, Wainapel says. 16. Eat early, not late. It’s better for your waistline to eat a big breakfast and small dinner. That’s because you’re more likely to include high-calorie foods (like dessert), according to 2012 research at the Salk Institute in La Jolla, Calif. 17. Eat more often. Eat five small meals, not three larger ones, Wainapel advises. Eating more frequently keeps your blood sugar levels even and prevents you from getting so hungry that you eat consume more than you should. 18. Fill up on protein. Eat protein at every meal to stay full longer. “Carbohydrates [alone] won’t keep you full for long,” Wainapel says.