The effects of bariatric surgery in knee osteoarthritis (OA)
Weight, especially those who are classed as overweight and obese (Body Mass Index, BMI >30), is regarded as one of the most modifiable to risk factors in those who suffer with osteoarthritis (OA).
With this in mind, the authors of this study have looked at the benefits of combining bariatric surgery with diet and exercise changes, to see if this could delay the need for a total knee replacement (TKR) surgery.
This study included 30 participants (20 female, 10 male) who were classified as morbidly obese (BMI >40) and were also diagnosed with having Grade IV Kellgren and Lawrence classified knee OA. Participants had been trying to modify their weight with diet and exercise alone, but this had not yielded enough result.
Outcome measures that were used to evaluate both development and progression of OA included the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and a standardized self-administered questionnaire. The WOMAC score was taken at baseline, after 3 and after 6 months of follow-up.
Participants underwent one of 3 kinds of bariatric surgery: laparoscopic sleeve gastrectomy, mini gastric bypass, and Roux-en-Y gastric bypass.
This study showed a significant correlation between pain and weight reduction, but stiffness of the affected knee did not improve. All of the types of weight loss surgeries were found to be equally effective.
An important limitation of this study was the potential lack in protein intake, which may result in decreased muscle mass and strength around the knee. The authors noted this could be a longer-term limitation for knee function. Nevertheless, at the 6-month follow-up pain reduction and improved knee function were still significant.
While many still struggle with the secondary effects of excess weight, such as pain and decreased mobility, this article makes an argument that one (less invasive) procedure could be beneficial in 2 growing issues: obesity, and associated pain and function.
Therefore, the combination of dietician input to ensure appropriate protein intake, along with physiotherapy and bariatric surgery could be a suitable and less invasive option to delay TKR surgery.
> From: Rishi et al., J Minim Access Surg 14 (2018-02-14 19:42:08) 13-17 (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.