Skip to main content
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology 5/2018

28.12.2017 | Original Article • KNEE - ARTHROPLASTY

Management of symptomatic knee osteoarthritis in obesity: a survey of orthopaedic surgeons’ opinions and practice

verfasst von: Daniel S. Hill, Matthew Freudmann, Jamie C. Sergeant, Tim Board

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 5/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction

The aim of this survey was to explore knee surgeons’ opinions and practices regarding the management of symptomatic knee osteoarthritis in obesity.

Methods

Questionnaires were sent electronically to all consultant members of the British Association for Surgery of the Knee.

Results

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.

Discussion

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.

Conclusion

Our survey has shown considerable variation in the opinions and practice of surgeons on the management of symptomatic knee osteoarthritis in obesity, together with divided views on current literature.
Literatur
1.
Zurück zum Zitat Americian Association of Orthopaedic Surgeons (2013) Treatment of osteoarthritis of the knee evidenced based guideline, 2nd edn. Americian Association of Orthopaedic Surgeons, Rosemont Americian Association of Orthopaedic Surgeons (2013) Treatment of osteoarthritis of the knee evidenced based guideline, 2nd edn. Americian Association of Orthopaedic Surgeons, Rosemont
2.
Zurück zum Zitat National Institute for Health and Care Excellence (2014) Obesity: identification, assessment and management. National Institute for Health and Care Excellence, London National Institute for Health and Care Excellence (2014) Obesity: identification, assessment and management. National Institute for Health and Care Excellence, London
3.
Zurück zum Zitat Watts CD, Wagner ER, Houdek MT, Osmon DR, Hanssen AD, Lewallen DG et al (2014) Morbid obesity: a significant risk factor for failure of two-stage revision total knee arthroplasty for infection. J Bone Joint Surg Am Vol 96(18):e154CrossRef Watts CD, Wagner ER, Houdek MT, Osmon DR, Hanssen AD, Lewallen DG et al (2014) Morbid obesity: a significant risk factor for failure of two-stage revision total knee arthroplasty for infection. J Bone Joint Surg Am Vol 96(18):e154CrossRef
4.
Zurück zum Zitat Houdek MT, Wagner ER, Watts CD, Osmon DR, Hanssen AD, Lewallen DG et al (2015) Morbid obesity: a significant risk factor for failure of two-stage revision total hip arthroplasty for infection. J Bone Joint Surg Am Vol 97(4):326–332CrossRef Houdek MT, Wagner ER, Watts CD, Osmon DR, Hanssen AD, Lewallen DG et al (2015) Morbid obesity: a significant risk factor for failure of two-stage revision total hip arthroplasty for infection. J Bone Joint Surg Am Vol 97(4):326–332CrossRef
5.
Zurück zum Zitat Sridhar MS, Jarrett CD, Xerogeanes JW, Labib SA (2012) Obesity and symptomatic osteoarthritis of the knee. J Bone Joint Surg Br Vol 94(4):433–440CrossRef Sridhar MS, Jarrett CD, Xerogeanes JW, Labib SA (2012) Obesity and symptomatic osteoarthritis of the knee. J Bone Joint Surg Br Vol 94(4):433–440CrossRef
6.
Zurück zum Zitat Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D (2012) The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am Vol 94(20):1839–1844CrossRef Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D (2012) The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am Vol 94(20):1839–1844CrossRef
7.
Zurück zum Zitat Rodriguez-Merchan EC (2014) The influence of obesity on the outcome of TKR: can the impact of obesity be justified from the viewpoint of the overall health care system? HSS J Musculoskelet J Hosp Spec Surg 10(2):167–170 Rodriguez-Merchan EC (2014) The influence of obesity on the outcome of TKR: can the impact of obesity be justified from the viewpoint of the overall health care system? HSS J Musculoskelet J Hosp Spec Surg 10(2):167–170
8.
Zurück zum Zitat Murgatroyd SE, Frampton CM, Wright MS (2014) The effect of body mass index on outcome in total hip arthroplasty: early analysis from the New Zealand Joint Registry. J Arthroplasty 29(10):1884–1888CrossRefPubMed Murgatroyd SE, Frampton CM, Wright MS (2014) The effect of body mass index on outcome in total hip arthroplasty: early analysis from the New Zealand Joint Registry. J Arthroplasty 29(10):1884–1888CrossRefPubMed
10.
Zurück zum Zitat Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737CrossRefPubMed Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737CrossRefPubMed
11.
Zurück zum Zitat Smith TO, Aboelmagd T, Hing CB, MacGregor A (2016) Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis. Bone Joint J 98-b(9):1160–1166CrossRefPubMed Smith TO, Aboelmagd T, Hing CB, MacGregor A (2016) Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis. Bone Joint J 98-b(9):1160–1166CrossRefPubMed
12.
Zurück zum Zitat Royal College of Surgeons of England (2017) Patient access to bariatric surgery. Royal College of Surgeons of England, London Royal College of Surgeons of England (2017) Patient access to bariatric surgery. Royal College of Surgeons of England, London
15.
Zurück zum Zitat National Institute for Health and Care Excellence (2015) Osteoarthritis NICE quality standard [QS87]. Quality statement 5: weight loss. June 2015 National Institute for Health and Care Excellence (2015) Osteoarthritis NICE quality standard [QS87]. Quality statement 5: weight loss. June 2015
17.
Zurück zum Zitat Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ et al (2014) 45-day mortality after 467 779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. The Lancet 384(9952):1429–1436CrossRef Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ et al (2014) 45-day mortality after 467 779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. The Lancet 384(9952):1429–1436CrossRef
18.
Zurück zum Zitat Amin AK, Patton JT, Cook RE, Brenkel IJ (2006) Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Bri Vol 88(3):335–340CrossRef Amin AK, Patton JT, Cook RE, Brenkel IJ (2006) Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Bri Vol 88(3):335–340CrossRef
19.
Zurück zum Zitat Groen VA, van de Graaf VA, Scholtes VA, Sprague S, van Wagensveld BA, Poolman RW (2015) Effects of bariatric surgery for knee complaints in (morbidly) obese adult patients: a systematic review. Obes Rev Off J Int Assoc Study Obes 16(2):161–170CrossRef Groen VA, van de Graaf VA, Scholtes VA, Sprague S, van Wagensveld BA, Poolman RW (2015) Effects of bariatric surgery for knee complaints in (morbidly) obese adult patients: a systematic review. Obes Rev Off J Int Assoc Study Obes 16(2):161–170CrossRef
20.
Zurück zum Zitat Martin JR, Watts CD, Taunton MJ (2015) Bariatric surgery does not improve outcomes in patients undergoing primary total knee arthroplasty. Bone Joint J 97-b(11):1501–1505CrossRefPubMed Martin JR, Watts CD, Taunton MJ (2015) Bariatric surgery does not improve outcomes in patients undergoing primary total knee arthroplasty. Bone Joint J 97-b(11):1501–1505CrossRefPubMed
21.
Zurück zum Zitat Royal College of Surgeons of England (2016) Smokers and overweight patients: soft targets for NHS savings? Royal College of Surgeons of England, London Royal College of Surgeons of England (2016) Smokers and overweight patients: soft targets for NHS savings? Royal College of Surgeons of England, London
22.
Zurück zum Zitat Academy of Medical Royal Colleges (2013) Measuring up: the medical profession’s prescription for the nation’s obesity crisis. Academy of Medical Royal Colleges, London Academy of Medical Royal Colleges (2013) Measuring up: the medical profession’s prescription for the nation’s obesity crisis. Academy of Medical Royal Colleges, London
23.
Zurück zum Zitat Royal College of Physicians (2010) The training of health professionals for the prevention and treatment of overweight and obesity. Royal College of Physicians, London Royal College of Physicians (2010) The training of health professionals for the prevention and treatment of overweight and obesity. Royal College of Physicians, London
24.
Zurück zum Zitat Booth HP, Prevost AT, Gulliford MC (2015) Access to weight reduction interventions for overweight and obese patients in UK primary care: population-based cohort study. BMJ Open 5(1):e006642CrossRefPubMedPubMedCentral Booth HP, Prevost AT, Gulliford MC (2015) Access to weight reduction interventions for overweight and obese patients in UK primary care: population-based cohort study. BMJ Open 5(1):e006642CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Blackburn M, Stathi A, Keogh E, Eccleston C (2015) Raising the topic of weight in general practice: perspectives of GPs and primary care nurses. BMJ Open 5(8):e008546CrossRefPubMedPubMedCentral Blackburn M, Stathi A, Keogh E, Eccleston C (2015) Raising the topic of weight in general practice: perspectives of GPs and primary care nurses. BMJ Open 5(8):e008546CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane Database Syst Rev 8:Cd003641 Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane Database Syst Rev 8:Cd003641
27.
Zurück zum Zitat Courcoulas AP, Belle SH, Neiberg RH, Pierson SK, Eagleton JK, Kalarchian MA et al (2015) Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg 150(10):931–940CrossRefPubMedPubMedCentral Courcoulas AP, Belle SH, Neiberg RH, Pierson SK, Eagleton JK, Kalarchian MA et al (2015) Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg 150(10):931–940CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Welbourn RSA, Small P, et al (2014). National bariatric surgery registry: second report Welbourn RSA, Small P, et al (2014). National bariatric surgery registry: second report
29.
Zurück zum Zitat Campaign AR (2009) Osteoarthritis and obesity. A report by the Arthritis Research Campaign Campaign AR (2009) Osteoarthritis and obesity. A report by the Arthritis Research Campaign
Metadaten
Titel
Management of symptomatic knee osteoarthritis in obesity: a survey of orthopaedic surgeons’ opinions and practice
verfasst von
Daniel S. Hill
Matthew Freudmann
Jamie C. Sergeant
Tim Board
Publikationsdatum
28.12.2017
Verlag
Springer Paris
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 5/2018
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-017-2103-9

Weitere Artikel der Ausgabe 5/2018

European Journal of Orthopaedic Surgery & Traumatology 5/2018 Zur Ausgabe

Technical Note • HAND - TRAUMA

A useful dressing for isolated digit injuries

Editorial • GENERAL ORTHOPAEDICS - MINIMAL SURGERY

What is minimally invasive surgery?

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.