Management of symptomatic knee osteoarthritis in obesity: a survey of general practitioners' opinions and practice (original) (raw)
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European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2017
The aim of this survey was to explore knee surgeons' opinions and practices regarding the management of symptomatic knee osteoarthritis in obesity. Questionnaires were sent electronically to all consultant members of the British Association for Surgery of the Knee. The response rate was 52%. The survey showed considerable practice variation and divided opinion on the evidence base. The majority stated that weight loss should be the first-line treatment. 53% (91/172) stated that such cases should ideally be assessed by a specialist multidisciplinary service; however, only 24% (41/169) would be interested in being the orthopaedic surgeon in such a service. The optimal pathway of care for the obese patient with symptomatic knee osteoarthritis remains unclear. Given recent debate around the rationing of knee arthroplasty surgery in obesity, we felt it was timely to survey knee surgeons' current practice. Our survey has shown considerable variation in the opinions and practice of...
Annals of the Rheumatic Diseases, 2011
Objective T o evaluate 1-year symptomatic improvement in obese patients with knee osteoarthritis (OA) on an intensive low-energy diet (LED) maintained by frequent consultations with a dietician compared to minimal attention. Methods The LED programme consisted of group therapy with dietary consultations and two periods of a low-calorie diet of 810 kcal/day during weeks 0-8 and weeks 32-36. The control group only received dietary instruction and attention for 2 h at baseline, and at weeks 8, 32, 36 and 52. The primary end point (total Western Ontario and McMaster Universities (WOMAC) index) was assessed as the mean group difference during and after 1 year.
Osteoarthritis and Cartilage, 2022
Background: While targeting obesity is central to osteoarthritis management, recent meta-analyses demonstrate that signi cant weight loss has only modest effects on symptoms, and no effect on structure. In countries such as USA, adults gain on average 0.5 to 1 kilogram per year from early to middle adulthood. Preventing weight gain is easier to achieve and sustain than weight loss and reduces knee pain. The World Health Organisation has recommended that effective management of obesity should include prevention of weight gain, weight maintenance as well as weight loss; however, it is unclear whether such recommendations appear in guidelines for osteoarthritis. Therefore, we systematically reviewed the recommendations and approaches for weight management in all current clinical practice guidelines (CPGs) for osteoarthritis. Methods: Nine databases were searched (1st January 2010 to 15th March 2022) to identify guidelines informing the non-pharmacological management of osteoarthritis. Three reviewers appraised guidelines according to the AGREE II instrument, and independently extracted data on their characteristics. One author extracted and summarised guideline recommendations on weight management. This systematic review is registered on PROSPERO (CRD42021274195). Results: Fifteen CPGs from developed and developing countries were included. Weight loss was recommended for knee (12 of 13 guidelines) and hip (10 of 11 guidelines) but not hand (0 of 4 guidelines) osteoarthritis. Combination approaches of diet and/or exercise were recommended for overweight or obese individuals in knee (8 of 12) and hip (4 of 10) osteoarthritis, with 2 guidelines specifying ≥5% weight loss. One of 15 guidelines speci ed strategies for weight loss and maintenance of lost weight. Two of 15 guidelines recommended controlling body weight for osteoarthritis, regardless of obesity status. There was discordance between strength of recommendation for weight loss and level of evidence in 3 of 15 guidelines. The included guidelines had a median AGREE II domain score of 78.7% (interquartile range 71.4, 87.9). Conclusion: Most CPGs for knee and hip osteoarthritis recommend weight loss to manage obesity in osteoarthritis despite evidence for modest bene t. Given weight gain is common in adults, other approaches such as preventing weight gain should be considered to improve outcomes in osteoarthritis.
Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial
Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 2005
We wanted to assess the effect of rapid diet-induced weight loss on the function of obese, knee osteoarthritis (OA) patients. Eighty patients with knee OA, 89% women (n=71), were recruited. Mean (SD) body-mass index (BMI) was 35.9 (5.1) kg/m(2) and age 62.6 (11.1) years. Patients were randomized to either a low-energy diet (LED 3.4MJ/day), or a control diet (5MJ/day). The LED group had weekly dietary sessions, whereas the control group was given a booklet describing weight loss practices. Changes in body weight and body composition were examined as independent predictors of changes in knee OA symptoms. Symptoms were monitored by the Western Ontario and McMaster Universities' (WOMAC) OA index. The LED and control group lost a mean (SE) of 11.1 (0.6)% and 4.3 (0.6)%, respectively, with a mean difference being 6.8% (95% confidence interval (CI): 5.5 to 8.1%; P<0.0001). The decrease in body fat percent was higher in the LED group, 2.2% (1.5 to 3.0%; P<0.0001). The total WOMAC ...
Obesity and knee osteoarthritis
Inflammopharmacology, 2012
Background The association between obesity and knee osteoarthritis, and specifically the role of obesity as a risk factor for knee osteoarthritis has been well documented. A systematic review and meta-analysis by Blagojevic et al. in Osteoarthr Cartil 18(1):24-33, (2010) examined 36 papers reporting on BMI and found that all studies demonstrated obesity and being overweight to be risk factors for knee osteoarthritis. The effect size for obesity as a risk factor for knee OA was reported to be I 2 = 97%, and the random effects pooled odds ratio for obesity compared to normal weight was 2.63 with a 95% CI of 2.28-3.05. Objective This review summarises recent findings involving the association between knee osteoarthritis and obesity: the potential mechanisms of the link between the two disease states; and the potential benefits of weight loss on obese, knee osteoarthritis patients. Methods Studies for inclusion in our report were identified using: MEDLINE; EMBASE; PUBMED; Cochrane Central Register of Controlled Trials; CINAHL; and reference lists of relevant articles. Main results A number of recent studies involving the association between obesity and knee osteoarthritis have since been published. A large, population-based prospective study (n = 823) conducted by Toivanen et al. with a follow-up of 22 years found that the risk for knee osteoarthritis was 7 times greater for people with BMI C30 compared to the control of people with BMI \25. A prospective cohort study of the Norwegian population by Grotle et al. that followed 1,675 patients reported that BMI [30 was significantly associated with osteoarthritis of the knee, with odds ratio of 2.81, and 95% CI of 1.32-5.96. Lohmander et al. found that in a large cohort study of 27,960 patients from the Swedish population, the relative risk for knee osteoarthritis (fourth quartile compared to first quartile) was 8.1, with a 95% CI of 5.3-12.4. Finally, a case-control study from Holliday et al. with 1,042 knee osteoarthritis patients and 1,121 matched controls reported that the adjusted odds ratio for knee osteoarthritis in patients with BMI [30 was 7.48 with 95% CI of 5.45-10.27.
Objective: the aim of our work was to study the effects of physical therapy versus weight reduction and their combined effects in obese patients with knee OA. Methods: 156 obese patients (137 females and 19 males) with knee OA were recruited. their BMIs ranged from 30.2 to 50.8. Patients were randomized to three groups: Group I: underwent physical therapy only. Group II: underwent weight reduction only. Group III: underwent combined physical therapy and weight reduction. Changes in body weight and body composition were examined as independent predictors of changes in knee OA symptoms. Symptoms were monitored by the Western Ontario and McMaster Universities? (WOMAC) OA index. Results: the mean changes of group II and III (-16.9 ?2.7 and -15.7 ?2) were highly significant respectively while mean change of group I (-0.6 ?0.4) was non significant. Group II had the best improvement of BMI with mean change of (-6.6 ?0.8) followed by group III (-4.9 ?0.7 ) while group I had the worst (-0.3 ?0.2) . The total WOMAC index improved within each group after two and four months from baseline (p < 0.001), The best mean change of WOMAC score was found in group III (-14.8 ?49). Conclusion: Combination of both weight reduction and physical therapy gives better results as regard improving knee pain and function in patients with OA, reduces disability and improves quality of life compared to each method alone.
Obesity and disability in the symptomatic Irish knee osteoarthritis population
Irish Journal of Medical Science, 2010
Background Osteoarthritis (OA) of the knee is a common disorder with significant social and financial implications. Obesity is the strongest modifiable risk factor of knee OA. There is little data on obesity in Irish knee OA populations and its relationship to other measures of disease severity. Aims In Beaumont Hospital, we have been collecting data on patients presenting with knee OA as part of a screening process for potential candidates for therapeutic exercise intervention studies. Here, we present data on the first 96 candidates screened during this process. Results The mean body mass index (BMI) of the group fell within the obese range (31); indeed, only 21% had a normal BMI. The vast majority of our patients had severe self-reported disability. In contrast, the distribution of radiographic severity of knee OA was more even. There was no significant relationship between radiographic severity and disability. BMI did predict disability but had a weak correlation. Radiographic severity did not correlate with BMI. Conclusion Irish patients with knee OA referred for physiotherapy were very disabled, significantly obese and represent a challenging cohort of patients to treat.
Annals of the Rheumatic Diseases, 2006
This review aims to assess by meta-analysis of randomised controlled trials (RCTs) changes in pain and function when overweight patients with knee osteoarthritis (OA) achieve a weight loss. Systematic searches were performed and reference lists from the retrieved trials were searched. RCTs were enclosed in the systematic review if they explicitly stated diagnosis of knee OA and reported a weight change as the only difference in intervention from the control group. Outcome Measures for Arthritis Clinical Trials III outcome variables were considered for analysis. Effect size (ES) was calculated using RevMan, and meta-regression analyses were performed using weighted estimates from the random effects analyses. Among 35 potential trials identified, four RCTs including five intervention/ control groups met our inclusion criteria and provided data from 454 patients. Pooled ES for pain and physical disability were 0.20 (95% CI 0 to 0.39) and 0.23 (0.04 to 0.42) at a weight reduction of 6.1 kg (4.7 to 7.6 kg). Meta-regression analysis showed that disability could be significantly improved when weight was reduced over 5.1%, or at the rate of .0.24% reduction per week. Clinical efficacy on pain reduction was present, although not predictable after weight loss. Metaregression analysis indicated that physical disability of patients with knee OA and overweight diminished after a moderate weight reduction regime. The analysis supported that a weight loss of .5% should be achieved within a 20-week period-that is, 0.25% per week.
Journal of Ideas in Health
Background: Obese individuals are at increased risk for many chronic and life-threating conditions. The most significant burden on the musculoskeletal system resulted from osteoarthritis, mainly knee osteoarthritis. This study aimed to determine the prevalence of obesity and central obesity among a group of patients with knee osteoarthritis, analyze the effect of demographic variables, and examine the relationship between these two types of obesity. Methods: A cross-sectional study was conducted in Al-Sadder hospital in Baghdad from June through September 2017. A convenience sample of 200 patients with knee osteoarthritis was collected. Those with body mass index (BMI) equal to or more than (30 kg/m2) considered obese. The cutoff point for central obesity was the waist-hip ratio (WHR) above (0.9) for men and above (0.85) for women. The risk ratio and 95% confidence interval (95% CI) calculated to determine the strength of the relationship. P-value ≤ 0.05 was considered statistically...