OBESITY & ARTHRITIS Dr(Prof)RAJU VAISHYA MS, MCh(L’pool), frcs (eng) President, Arthritis Care Foundation & Senior Consultant Orthopaedic Surgeon Indraprastha Apollo Hospitals

Obesity & Knee Arthritis A 1680 painting by Juan Carreno de Miranda of a girl presumed to have Prader–Willi syndrome.

Problem of Obesity A leading preventable cause of death worldwide Increasing prevalence in adults and children One of the most serious public health problems of the 21st century In 2013, the American Medical Association classified obesity as a disease.

BMI: Weight (kgs)/Height2 (mts) What is Obesity? A medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. When the body mass index (BMI) exceeds 30 kg/m2 BMI: Weight (kgs)/Height2 (mts)

Osteoarthritis: What Is It? Also called "wear and tear" arthritis or degenerative joint disease. Osteoarthritis (OA) is the progressive breakdown of the joints' natural shock absorbers. Most people over 60 have some degree of OA, but it also affects people in their 20s and 30s.

Causes of Obesity Combination of factors: a) Excessive food energy intake b) Lack of physical activity c) Genetic susceptibility d) Endocrine disorders (hypothyroid, Cushing) e) Medications (steroids , hormones etc) f) Psychiatric illness (depression etc)

Implications of obesity on health Increases the likelihood of various diseases: *Heart diseases *Diabetes (type II) *Obstructive sleep apnea *Certain types of cancer *Osteoarthritis

Obesity & Knee Arthritis (A vicious cycle)

Pathology behind Obesity and Knee Osteoarthritis While walking or bearing the weight on a single leg with each step while walking, a force of 3 to 6 times that of body weight is transmitted across the knee joint. These forces are increased several times over during high-impact activities. In fact only 10 pounds overweight can increase the force on the knee by 30-60 pounds with each step. In addition there are excessive fat tissues that produce hormones and other factors that affect the articular or joint cartilage metabolism and cause inflammation of the joints giving rise to joint pathology. Leptin is one of the hormones associated with obesity induced knee osteoarthritis.

Pathology of Arthritis

Osteoarthritis: What Causes It? Every joint comes with a natural shock absorber in the form of cartilage. This firm, rubbery material cushions the ends of the bones and reduces friction in healthy joints. As we age, joints become stiffer and cartilage is more vulnerable to wear and tear. At the same time, repetitive use of the joints over the years irritates the cartilage. If it deteriorates enough, bone rubs against bone, causing pain and reducing range of motion

Unavoidable Risk Factors Aging Female gender Genetic defect Joint abnormality

Osteoarthritis: Symptoms The symptoms tend to develop slowly Pain or soreness on moving the joint Joint stiffness Deformity Crepitus (‘creaky’) noises

X-rays

Weight loss benefits for arthritis patients Preventing arthritis and its complications Improvement of symptoms of Arthritis Bariatric surgeries (weight loss surgery) : not only decreases obesity but also decreases osteoarthritis incidence and symptoms

Avoidable Risk Factors Injury to the joint -Sports - Jobs that require repetitive motion, such as bending the knees to install flooring. * Obesity

Prevalence of Osteoarthritis An estimated 1 billion people worldwide (WHO). 1/3rd population in developed nations (USA, UK etc) 34 million US adults are obese, and 13 million of these are morbidly or severely obese. Indian figures not available (but incidence is increasing rapidly)

Obesity & TKR Obesity has been shown to be a risk factor for knee osteoarthritis TKR in the obese patient has given rise to some controversy in terms of peri operative risks, and the longevity of the implants. Condoning the obese patient with knee arthritis ?

Obesity & TKA Although arthritis is common in obese, many surgeons are reluctant to perform joint replacements in this population. Moderate obesity does not affect the clinical and radiologic outcome of TKA. TKA results in improved mobility, enhancing the success of subsequent weight loss therapy.

Post Bilateral TKR