Obesity and symptomatic osteoarthritis of the knee

Abstract

Given the growing prevalence of obesity around the world and its association with osteoarthritis of the knee, orthopaedic surgeons need to be familiar with the management of the obese patient with degenerative knee pain. The precise mechanism by which obesity leads to osteoarthritis remains unknown, but is likely to be due to a combination of mechanical, humoral and genetic factors. Weight loss has clear medical benefits for the obese patient and seems to be a logical way of relieving joint pain associated with degenerative arthritis. There are a variety of ways in which this may be done including diet and exercise, and treatment with drugs and bariatric surgery. Whether substantial weight loss can delay or even reverse the symptoms associated with osteoarthritis remains to be seen. Surgery for osteoarthritis in the obese patient can be technically more challenging and carries a risk of additional complications. Substantial weight loss before undertaking total knee replacement is advisable. More prospective studies that evaluate the effect of significant weight loss on the evolution of symptomatic osteoarthritis of the knee are needed so that orthopaedic surgeons can treat this patient group appropriately.

Patients With Hip Osteoarthritis Have a Phenotype With High Bone Mass and Low Lean Body Mass

“…However, even if there is evidence in the literature that overweight precedes the development of OA [8,23], we cannot state whether the deficit in muscle mass existed before the development of OA. High BMI may be a risk factor for perioperative and postoperative complications [31]. Finally, one of the most important findings of this study may be the low BMI adjusted lean mass found in patients with hip OA, as this may have clinical implications.…”

“…A high prevalence of OA also has been reported in obese patients and in weightbearing joints [4,6], partly referred to a high joint surface load [31]. However, primary OA also has been seen in nonweightbearing joints such as the thumb base and fingers [33,35].…”

Patients With Knee Osteoarthritis Have a Phenotype With Higher Bone Mass, Higher Fat Mass, and Lower Lean Body Mass

“…Our data indicate that there is no need for general preoperative screening of low BMD when planning for knee arthroplasty. High BMI is known as a risk factor for peri-and postoperative complications [28], and this group of patients should then be regarded as a risk cohort in this aspect. Furthermore, weight loss should be encouraged in this group of patients to reduce the mechanical load over the joint, and the proportionally low muscle mass indicates that these patients both pre-and postoperatively should be subjected to intense physical training as to improve the muscle protective ability.…”

“…Local factors such as chronic repeated loads, loads with high magnitude, ligament instability, neuromuscular impairment, and joint deformity may accelerate the degenerative process [5]. A high prevalence of OA has been reported in obese patients and in weightbearing joints [3,5], often referred to as high joint surface load [28]. Primary OA can also be found in nonweightbearing joints such as the base of the thumb and the fingers [30,32], and there are also differences in prevalence of primary OA in men and women [3,5].…”

Arthroplasty Features in Overweight Patients (Review)

“…В первую очередь, он вы-зван хирургическими инфекциями и венозной тромбоэмболией (ВТэ). Для артропластики риск развития сосудистых осложнений увели-чивается в 1,5 раза на каждые 5 кг/м 2 увеличе-ния ИМТ [54].…”