Happiness is Happy Knees Osteoarthritis and Obesity DR.A.V.GURAVA REDDY D. Orth, DNB Orth, FRCS (Edin), FRCS (Glas), M.Ch Orth (Liverpool) CEO & MANAGING DIRECTOR CHIEF JOINT REPLACEMENT SURGEON SUNSHINE HOSPITALS SECUNDERABAD
Obesity…… present day epidemic
How common is obesity???• 2/3 adults and 1/3 of children are obese• Three times more than 20 years ago• It is an established risk factor for many diseases• It costs 3 billion pounds per year to UK
Obese people think……. Painful and disabling disease an inevitable consequence of ageing at least for people who have the wrong genes.
Osteoarthritis and Obesity What you need to know?? • New research shows that the obese are up to four times as likely to develop knee osteoarthritis as they are to develop high blood pressure or type-2 diabetes.
How common is osteoarthritis • OA is most common form of arthritis. • Increase to be substantial in next 20 years • >1 million people visit their GP in a year due to OA. • Its twice prevalent than HTN and DM.
Osteoarthritisof the knee is themost prevalent formof large joint OAin the world.
Knee X-ray At Various stages Normal Stage IV Stage III
Osteoporosis is notsame as Osteoarthritis
Effects of obesity on patients • The danger to health and quality of life is insidious – at every stage, – excess body weight both increases the level of pain and disability – and undermines the efficacy of treatment. • HTN and DM can be controlled with weight loss but osteoarthritis is irreversible.
Obesity and osteoarthritis How is the damage done ??• Excessive loading of the joint --- --obesity causes osteoarthritis.• It is in the weight-bearing joints - the knee and to a lesser extent the hips• Because of the way the knee joint works, the effect of excess weight can be four or five times greater• Poor posture and unhealthy gait are more common in obese people,
Something about osteoarthritis• Osteoarthritis is the most common disease affecting the joints of the body, particularly the knees and hips.• It is estimated that over 6 million people over the age of 45 years in the UK have painful osteoarthritis in their knees
DOES EVERYBODYGET ARTHRITIS OF KNEES?
WHAT ARE THE SYMPTOMS?1. PAIN2. MORNING STIFFNESS3. SWELLING4. CREAKING SOUNDS5. DIFFICULTY IN SQUATTING6. DIFFICULTY IN STAIRS
The most significant symptom is anaching, sharp or burning pain that is madeworse with activity.Eventually, the cartilage wears awaycompletely ,worsening the pain andcausing difficulty in movementHowever, of preventable factors,obesity is far and away the singlebiggest cause of osteoarthritis inweight-bearing joints.The earlier someone becomes overweightor obese, the greater the risk ofdeveloping osteoarthritis.
CAN WE PREVENT OA?NO, BUT WE CANDELAY OR SLOW DOWN THE PROCESS
• Once entrenched, osteoarthritis is likely to have the effect of further reducing activity, bringing about increased weight gain.• As well as worsening osteoarthritis symptoms, this further increase in weight will also raise the risk of developing other obesity-related diseases. Obesity Increased Weight Early Osteoarthritis Reduced Activity
Obesity and Osteoarthritis – The need for surgery• As well as causing osteoarthritis to develop, persistent obesity increases the level of pain and disability while reducing the efficacy of pain-relieving drugs.• 2/ 3 TKR & ¼ THR IS DUE TO OBESITY
Obesity The bad news for surgery outcome• Knee and hip replacements are among the great success stories of modern surgery.• Research shows that nearly 50 per cent of obese patients have a poor outcome from joint replacement surgery compared to less than ten per cent of those with a healthy weight.
WHAT SHOULD I DO?1.KEEP FIT2.KEEP YOUR WEIGHT DOWN3.NO SQUATTING4.MINIMIZE STAIRS
Prevention is the best Medicine • Benefits of a healthy weight – Achieving a healthy weight reduces the risk of developing the disease in the first place, relieves existing symptoms and helps to prevent further deterioration. • There is increasing evidence that exercise is most effective in reducing both pain and mobility when combined with weight loss.
Bariatric surgery can behelpful in such patients to give better results of TKR and THR