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In both developed and developing countries, at least 2.8 million adults died due to excess body weight.
Bariatric
surgery when combined with dietary and exercise management resulted in signifcant
weight loss, reducedd knee pain and improved functions. With this approach, both
obesity and osteoarthritis (OA) issues can be taackled. It is a major step
forward in stemming the global epidemic of these two interlinked conditions.
In both developed and developing countries, at least 2.8
million adults died due to excess body weight. Therefore, obesity is considered
to be the fifth leading risk factor for deaths worldwide. The numerous types of
co-morbidities are reported to be associated with obesity such as diabetes,
dyslipidemia, obstructive sleep apnea, hypertension and joint pain of knee and
back. Recently, the association of obesity with diabetes has been increased
with an alarming rate. According to the World Health Organization (WHO),
approximately 1 billion people are overweight, and amongst them 300 million are
obese. Obesity is known to be the most significant risk factor for the
development of osteoarthritis (OA). The obese people are four times more likely
to have knee OA than those with healthy weight.
Various studies found that weight loss in OA patients leads
to a significant improvement in their OA symptoms. An observational study
conducted by Framingham et al showed
that only 5 kg reduction in body weight decreases the risk of developing knee
OA. One more review by Messier et al
also showed similar results, but they used combinations of diet and exercises
weight reduction process in their study. With the increased prevalence of
obesity, a need for joint replacement surgery was found to increase. Total knee
replacement (TKR) is a highly prevalent and expensive surgical procedure.
Although TKR helps in reducing pain in most patients, it does not resolve many
of functional limitations associated with chronic knee arthritis that existed
before the surgery. For the obese patients, the bariatric surgery came as a
boon that removes up to 60-70% of excess body weight by changing the digestive
system's anatomy and limiting the amount of food. Also, it significantly
reduces the knee pain in OA patients.
Therefore, in the present study, the role of bariatric
surgery with dietary and exercise changes on knee pain in overweight and
morbidly obese OA patients making a way to delay the need for knee replacement
was evaluated.
Rationale behind the research:
Various studies determined the
beneficial effect of bariatric surgery on the knee OA, but none of the studies
evaluated the synergistic effect of surgery and lifestyle modifications on the
progress of OA.
Therefore, in the present study,
Lajja Rishi et al. evaluated the combinational effect of bariatric
surgery and dietary and exercise modifications on the development of knee OA.
Objective:
To find the weight reduction
pattern and its outcome on knee pain and function in OA morbidly obese
patients’ post-bariatric surgery with dietary and exercise changes.
Study outcome measures:
Time period: Baseline, 3 months and 6 months.
Study Outcomes
As a result of bariatric surgery, there is as significant reduction in weight and BMI after 3 and 6 months postoperatively (p<0.0001). There was also a significant reduction in pain, stiffness and ADL after 3 and 6 months postoperatively (Figure 1).
Significant correlation of percentage changes in BMI with percentage change of pain (r=0.479, P=0.007) and ADL (r= 0.414, P= 0.023) was observed. However, no correlation was seen with percentage stiffness change (r=−0.175, P=0.356).
On comparing the types of surgery with respect to 6th-month weight loss, change in BMI and WOMAC score parameters, all the surgeries (LSG, MGB and LGB) gave insignificant results showing that all the surgeries are equally capable of reducing weight and improving BMI.
In this
study, it seemed that bariatric surgery is beneficial for weight-bearing knee
joint paint. Obesity-related OA is multifaceted, can be due to the mechanical factor,
which includes increased pressure on the joint, which results in decreased
joint space, muscle strength and altered biomechanics. Another one the aging
and metabolic factor in which adipokine levels produce the biomechanical
environment where chondrocytes do not respond to challenges.
Numerous
studies have found the moderate-to-strong correlation between knee OA and
obesity. With the advanced technology, the surgical management of knee pain has
developed, i.e., knee replacement. But the outcome was also questionable due to
intra- and post-operative reasons such as higher incidence of wound dehiscence,
superficial infections, thromboembolic events, higher intraoperative blood loss
leading to longer operative time, early failure, high revision rates and
malposition of implants.
On the
other hand, the outcome of bariatric surgery before orthopedic surgery reported
being effective in weight loss, and many orthopedic surgeons prefer this in
managing obesity before performing knee replacement surgery. The results of the
current study showed a significant positive correlation between BMI and pain.
Supportive research showing the effect of weight reduction on eighty knee OA
patients found that with 10% weight reduction, the function was increased by
28%. Maybe future research and the follow-up study is needed to see the
long-term change of weight reduction on stiffness and need for TKR.
In addition, the combination of protein-rich diet and physical exercise provides symptomatic relief from the knee pain. Therefore, researchers encouraged the patients to continue knee exercises further with some modifications to overcome degenerative changes due to aging in future.
Bariatric surgery with dietary and exercise changes is an
important tool for both prevention and management of obesity with OA.
NA
Combination of bariatric surgery with dietary and exercise changes might helpful in the reduction of body weight and knee pain.
J Minim Access Surg. 2018 Jan-Mar;14(1):13-17
Can bariatric surgery delay the need for knee replacement in morbidly obese osteoarthritis patients
Lajja Rishi et al.
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