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Bariatric Surgery For Osteoarthritis Of Hips And Knees?



Osteoarthritis in hips and knees is a common progressive disease leading to joint pain and severe disability. It is a complex multifactorial condition leading to damage of cartilage, deposition of subchondral bone matrix and release of pro-inflammatory cytokines.

One of the most common risk factors for osteoarthritis is carrying around excess weight. In fact, no matter what the root cause of the problem (trauma or otherwise), weight loss has consistently been shown to reduce pain (for e.g. each lb lost takes about four pounds off each knee).

So the question arises, whether bariatric surgery should be used more commonly in obese patients with osteoarthritis in hips or knees.

In a paper authored by Richdeep Gill and other colleagues, just published in Obesity Reviews, we report our findings from a systematic review of the literature on bariatric surgery and osteorarthritis.

A comprehensive search of electronic databases using broad search terms revealed a total of 400 articles, including six studies, which met our criteria for inclusion in our qualitative analysis.

Although there was a clear trend towards improvement of hip and knee osteoarthritis in hips and knees following bariatric surgery, the data consists largely of case series.

Thus, it may well be time to conduct a large randomized controlled trial to determine whether or not bariatric surgery should perhaps be routinely considered as a means to better manage hip or knee osteoarthritis in patients with severe obesity.

AMS
Edmonton, Alberta

Gill RS, Al-Adra DP, Shi X, Sharma AM, Birch DW, & Karmali S (2011). The benefits of bariatric surgery in obese patients with hip and knee osteoarthritis: a systematic review. Obesity reviews : an official journal of the International Association for the Study of Obesity PMID: 21883871

6 Comments

  1. Dr. Sharma,

    As one who has undergone bilateral hip replacement surgery in the last three years, largely as a result of obesity – but there were also many other “life” factors involved – I can tell you from an experience I wouldn’t wish on my worst enemy that when the pain reaches the non-stop, 24/7, “excruciating, ” almost unbearable, levels, (which it will) the ONLY solution is joint replacement surgery.

    Sure, I agree that bariatric surgery does significantly reduce the force exerted on the hip and knee joints with every step you take, but first things first. And, in that vein, I have also lost 163 lbs. over the past year and kept it off. In fact, my surgeon “forced” me to lose 50 lbs. before he would even perform the first surgery, telling me, “I simply don’t have a product for you.”

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  2. Bariatric surgery should not be considered a remedy for joint problems. I strongly suspect that it is more expensive and riskier than joint replacement surgery. Its whole purpose is to damage a healthy digestive system.

    If a patient has a bad joint and you offer bariatric surgery as a remedy, then the patient will continue to have a bad joint and will add a damaged digestive system to their woes. If they have a bad joint and they get it replaced, then they will recover mobility without compromising their stomach.

    I had a joint replacement two years ago. I’m now back to being able to do everything I could do before my hip started to act up. If I’d had weight loss surgery instead, where would I be now? At best, unable to eat my beloved veggie-heavy diet and popping supplements to make up for all the nutritional deficiencies caused by the surgery. At worst, dead or dealing with horrible problems caused by the surgery. And I’d still have a bad hip and limited mobility.

    I had to have surgery after the car accident (the same one that caused my trauma-induced osteoarthritis) in order to remove intestinal scar tissue that was causing me horrible pain and making me throw up every time I tried to eat a normal sized meal. (Yes, it was like free weight loss surgery, and yet the doctors considered it an injury and fixed it!) I would never, ever agree to have that injury reinstated so that I could lose weight, nor would I agree to any type of abdominal surgery under lesser circumstances. The intestinal blockage was awful. Yes, I lost some weight, but I’d never felt so unhealthy before and haven’t since. The surgery was also awful; much worse than the joint replacement.

    I certainly hope that refusing joint replacement to fat people with osteoarthritis will not become a way to blackmail them into weight loss surgery. I may have a unique outlook on this, but I’m pretty sure that I’d rather be stuck in a wheelchair for the rest of my life than go back to having a condition that mimics that scar tissue blockage. And I say that as someone who enjoys being physically active and places a high value on mobility.

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  3. I can tell you from an experience I wouldnÔÇÖt wish on my worst enemy that when the pain reaches the non-stop, 24/7, ÔÇ£excruciating, ÔÇØ almost unbearable, levels, (which it will) the ONLY solution is joint replacement surgery.

    I’d like to agree that the pain from osteoarthritis is quite bad (although mine never got to be as serious as Jim’s – I was rarely in pain when I was at rest). I’d also like to add that the pain from the intestinal blockage was many times worse than the osteoarthritis. I would never, ever willingly do something that might put me back into that type of condition, and nobody else should be expected to either. I can’t even begin to express how a chance at becoming thin is not worth that risk. If people knew going in what an intestinal blockage feels like, I doubt you’d get very many people under the knife.

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  4. We have had some clients, who we once helped get approved for disability, actually be able to go back to work part time after having this surgery. Great post!

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  5. DeeLeigh not all Bariatric surgery turn out bad. There are people who had unbearable pain from osteoarthritis in knees and hips and after their surgery they are doing well and not carrying all that weight anymore. I’m sorry it didn’t turn out for you. We have to remember everybody is different

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