Obesity outcomes in disease management: clinical outcomes for osteoarthritis

High tibial osteotomy in obese patients: Is successful surgery enough for a good outcome?

INTRODUCTION

Knee osteoarthritis is the most common articular pathology. High tibial osteotomy (HTO) is a frequently used treatment procedure in medial osteoarthritis of the knee joint. We aimed to reveal factors that affect clinical and radiologic outcomes by evaluating the efficacy of HTO in patients with BMI ≥30 kg/m2 who were not appropriate for prostheses considering their activity, degree of pain, and age.

MATERIAL AND METHOD

HTO was performed using the medial open wedge technique who presented to the orthopedics polyclinic with symptoms of knee pain, whose BMI was over 30 kg/m2. All patients were diagnosed as having mechanical axis deviation and isolated medial compartmental arthrosis between 2013 and 2015.The clinical and radiologic follow-ups of patients were performed on day 45, at month 3, month 6, and after 1 year. The knee scoring system from the American Knee Society (AKS), and range of motion (ROM) were used in the functional evaluation of the patients.

RESULT

Eighteen patients were included in the study. Thirteen patients (72.2%) were women and 5 (27.8%) were men. Preop axis score was found significantly lower compared with the axis scores at postop month 6 and in final follow-up, the postoperative final follow-up axis score was found significantly lower than the axis score at month 6 (p < 0.05).

CONCLUSION

We anticipated in our study that the better outcomes obtained in the early period might be maintained for longer in parallel with weight loss and decreased BMI in the postoperative period. We believe that it is important to perform complication-free HTO with the correct technique, and by organizing a rapid and systematic weight loss process.

Prospective Study of Central versus Peripheral Obesity in Total Knee Arthroplasty

PURPOSE

Body mass index (BMI) is often used to predict surgical difficulty in patients receiving total knee arthroplasty (TKA); however, BMI neglects variation in the central versus peripheral distribution of adipose tissue. We sought to examine whether anthropometric factors, rather than BMI alone, may serve as a more effective indication of surgical difficulty in TKA.

MATERIALS AND METHODS

We prospectively enrolled 67 patients undergoing primary TKA. Correlation coefficients were used to evaluate the associations of tourniquet time, a surrogate of surgical difficulty, with BMI, pre- and intraoperative anthropometric measurements, and radiographic knee alignment. Similarly, Knee Injury and Osteoarthritis Outcome Score (KOOS) was compared to BMI.

RESULTS

Tourniquet time was significantly associated with preoperative inferior knee circumference (p=0.025) and ankle circumference (p=0.003) as well as the intraoperative depth of incision at the quadriceps (p=0.014). BMI was not significantly associated with tourniquet time or any of the radiographic parameters or KOOS scores.

CONCLUSIONS

Inferior knee circumference, ankle circumference, and depth of incision at the quadriceps (measures of peripheral obesity) are likely better predictors of surgical difficulty than BMI. Further study of alternative surgical indicators should investigate patients that may be deterred from TKA for high BMI, despite relatively low peripheral obesity.

Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management - United States, 2015

Problem/Condition

Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity.

Reporting Period

2015.

Description of System

The Behavioral Risk Factor Surveillance System is an annual, random-digit–dialed landline and cellular telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method.

Results

In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%–33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%–42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%–19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%–61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%–53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ≥14 physically unhealthy days during the past 30 days; ≥14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentage of leisure-time walking.

Interpretation

The prevalence, health-related characteristics, and management of arthritis varied substantially across states. The modeled prevalence of arthritis varied considerably by county.

Public Health Action

The findings highlight notable geographic variability in prevalence, health-related characteristics, and management of arthritis. Targeted use of evidence-based interventions that focus on physical activity and self-management education can reduce pain and improve function and quality of life for adults with arthritis and thus might reduce these geographic disparities.

Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation - United States, 2013-2015

Background

In the United States, doctor-diagnosed arthritis is a common and disabling chronic condition. Arthritis can lead to severe joint pain and poor physical function, and it can negatively affect quality of life.

Methods

CDC analyzed 2013–2015 data from the National Health Interview Survey, an annual, nationally representative, in-person interview survey of the health status and behaviors of the noninstitutionalized civilian U.S. adult population, to update previous prevalence estimates of arthritis and arthritis-attributable activity limitations.

Results

On average, during 2013–2015, 54.4 million (22.7%) adults had doctor-diagnosed arthritis, and 23.7 million (43.5% of those with arthritis) had arthritis-attributable activity limitations (an age-adjusted increase of approximately 20% in the proportion of adults with arthritis reporting activity limitations since 2002 [p-trend <0.001]). Among adults with heart disease, diabetes, and obesity, the prevalences of doctor-diagnosed arthritis were 49.3%, 47.1%, and 30.6%, respectively; the prevalences of arthritis-attributable activity limitations among adults with these conditions and arthritis were 54.5% (heart disease), 54.0% (diabetes), and 49.0% (obesity).

Conclusions and Comments

The prevalence of arthritis is high, particularly among adults with comorbid conditions, such as heart disease, diabetes, and obesity. Furthermore, the prevalence of arthritis-attributable activity limitations is high and increasing over time. Approximately half of adults with arthritis and heart disease, arthritis and diabetes, or arthritis and obesity are limited by their arthritis. Greater use of evidence-based physical activity and self-management education interventions can reduce pain and improve function and quality of life for adults with arthritis and also for adults with other chronic conditions who might be limited by their arthritis.

Morphologic differences between the hips of Chinese women and white women: could they account for the ethnic difference in the prevalence of hip osteoarthritis?

OBJECTIVE

Hip osteoarthritis (OA) is a common disabling disease, which has a much higher prevalence in whites than in Asians. The reasons for this ethnic difference in prevalence are unknown. Hip OA is often thought to be secondary to morphologic abnormalities. This study was undertaken to examine whether particular abnormalities predisposing to hip OA occur more frequently in whites and whether these differences in hip shape account for differences in the prevalence of OA.

METHODS

A morphometric study was performed on 400 hips of 200 female participants without OA from 2 studies, the Beijing OA Study and the Study of Osteoporotic Fractures from the US. We focused on measures of hip dysplasia and impingement (lateral center-edge angle, impingement angle, acetabular slope, femoral head-to-femoral neck ratio, and the crossover sign) and compared data from the hips of Chinese and white women.

RESULTS

Compared with their Chinese counterparts, white women had a lower mean impingement angle (83.6° versus 87.0°; P=0.03) and were more likely to have center-edge angles suggestive of impingement (>35°; 11% of hips in Chinese versus 23% of hips in whites, P=0.008). In contrast, low center-edge angles suggesting dysplasia (<20°) were found more often in Chinese women (22% of hips in Chinese versus 7% of hips in whites, P=0.005).

CONCLUSION

In a study of elderly women without signs of OA, the morphometry of impingement and asphericity was more common in the hips of white women compared with Chinese women. Our findings suggest that whites may be at higher risk of hip OA than Chinese because of morphologic findings that predispose whites to femoroacetabular impingement.

Tolerance of an aquatic power training program by older adults with symptomatic knee osteoarthritis

Objective. To determine the tolerance and feasibility of aquatic-based power training for improving lower limb muscle power, impairments, and mobility in adults with symptomatic knee OA. Participants. Twenty-nine adults, age 50 years and over, with symptomatic knee OA (ACR clinical criteria) and mobility limitation (400-meter walk time slower than median for sex and decade) completed 45-minute aquatic power training sessions twice weekly for 6 weeks. Main Outcome Measurements. Prospective outcomes included tolerance of the program, as well as change in stair climb power, 400-meter walk time, overall and knee-specific pain, activities of daily living (ADL), quality of life (QOL), and lower limb function at 6- and 12-week follow-up. Results. The training intensity required modification for 9 of the 29 participants. Lower limb muscle power, ADL, QOL, and overall pain were improved immediately and 6 weeks following completion (all P < 0.05). However, 400-meter walk times, and lower limb function did not differ from baseline. Conclusions. A 6-week aquatic rehabilitation program appears to be well tolerated by adults with symptomatic knee OA with mobility limitations and may result in improved lower limb muscle power, symptoms, ADL, and QOL. However, this intervention may have insufficient specificity or intensity for improving physical function.

Move to Improve: How Knee Osteoarthritis Patients Can Use Exercise to Enhance Quality of Life

Symptomatic knee osteoarthritis (OA) is a prevalent chronic degenerative disease that is associated with impaired quality of life and physical functioning. Although there is no cure for knee OA, regular exercise participation consistently results in improvements in quality of life, physical function, and knee OA symptoms. Findings from contemporary randomized controlled trials also demonstrate that lifestyle interventions involving modification of exercise and dietary behaviors yield superior improvements in relevant quality of life outcomes relative to either intervention alone.

Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline

OBJECTIVE

We sought to provide guidelines for the nutritional and endocrine management of adults after bariatric surgery, including those with diabetes mellitus. The focus is on the immediate postoperative period and long-term management to prevent complications, weight regain, and progression of obesity-associated comorbidities. The treatment of specific disorders is only summarized.

PARTICIPANTS

The Task Force was composed of a chair, five additional experts, a methodologist, and a medical writer. It received no corporate funding or remuneration.

CONCLUSIONS

Bariatric surgery is not a guarantee of successful weight loss and maintenance. Increasingly, patients regain weight, especially those undergoing restrictive surgeries such as laparoscopic banding rather than malabsorptive surgeries such as Roux-en-Y bypass. Active nutritional patient education and clinical management to prevent and detect nutritional deficiencies are recommended for all patients undergoing bariatric surgery. Management of potential nutritional deficiencies is particularly important for patients undergoing malabsorptive procedures, and strategies should be employed to compensate for food intolerance in patients who have had a malabsorptive procedure to reduce the risk for clinically important nutritional deficiencies. To enhance the transition to life after bariatric surgery and to prevent weight regain and nutritional complications, all patients should receive care from a multidisciplinary team including an experienced primary care physician, endocrinologist, or gastroenterologist and consider enrolling postoperatively in a comprehensive program for nutrition and lifestyle management. Future research should address the effectiveness of intensive postoperative nutritional and endocrine care in reducing morbidity and mortality from obesity-associated chronic diseases.

The effect of body mass index and hip abductor brace use on inpatient rehabilitation outcomes after total hip arthroplasty

OBJECTIVE

To determine the effect of body mass index and hip abductor brace use on inpatient rehabilitation outcomes after total hip replacement.

DESIGN

This was a retrospective, comparative study of natural course of rehabilitation care in 15 inpatient rehabilitation facilities. Patients with total hip replacement (n = 1947) and inpatient rehabilitation were stratified into four body mass index groups: nonobese (body mass index <25 kg/m2), overweight (25-29.9 kg/m2), moderately obese (30-40 kg/m2), severely obese (body mass index >or=40 kg/m2), and further stratified by hip abductor brace (brace, no brace). The proportions of patients in each group who used hip abductor braces ranged from 14.5%-17.5%. The main outcomes were length of stay, functional independence measure scores, facility-related charges, and discharge destination.

RESULTS

Length of stay was 0.8-1.3 days longer in the body mass index <25 kg/m2 group compared with the remaining body mass index groups (P < 0.05). Average improvement in total and motor functional independence measure scores ranged 53%-58% and 74%-83% across groups (both P < 0.001). Total rehabilitation charges were highest in the <25 kg/m2 body mass index group ($15,125 vs. $13,608-14,622; P < 0.0001). Hip brace use was associated with an average of $697 excess therapy/pharmacy charges during the rehabilitation stay, but no differences in other outcomes.

CONCLUSIONS

Severe obesity and abductor brace use do not impair rehabilitation functional gains or discharge home, but is related with excess rehabilitation costs. Hip abduction braces do not seem necessary during rehabilitation, particularly for obese patients.

American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient

American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.

American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient

American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.

Relationship between knee anthropometry and surgical time in total knee arthroplasty in severely and morbidly obese patients: a new prognostic index of surgical difficulty

BACKGROUND

Total knee arthroplasty (TKA) in patients with severe and morbid obesity is one of the current challenges in prosthetic knee surgery. The body mass index (BMI) is used to identify patients who may present difficulties during surgery and postoperative complications. We carried out a prospective study with an initial hypothesis that BMI is not associated with tourniquet time in obese patients undergoing TKA and that some anthropometric parameters may be useful in predicting tourniquet time in severely and morbidly obese patients.

METHODS

One hundred consecutive patients diagnosed with knee osteoarthritis with BMI > or =35 kg/m(2) scheduled for TKA were prospectively studied. Suprapatellar, infrapatellar, and supra/infrapatellar anthropometric indexes were calculated before surgery. The tourniquet time was determined.

RESULTS

The mean BMI was 39.81 kg/m(2) (SD +/- 3.75). A total of 58% of patients were classified as class III obesity (BMI 35-39.99) and 42% as class IV (BMI > or = 40) Mean tourniquet time was 41.67 min (SD +/- 9.26). There was no association between the BMI and tourniquet time. The suprapatellar index was negatively associated with tourniquet time (p < 0.038).

DISCUSSION

The BMI is not the only parameter that should be considered in order to identify severely and morbidly obese patients who may have more surgical difficulties during TKA. Preoperative determination of the suprapatellar index helped us to classify these patients according to the morphology of the knee and predicted a longer tourniquet time and, therefore, greater surgical difficulty, in patients with a suprapatellar ratio below 1.6 in this study.

Obesity and inpatient rehabilitation outcomes following knee arthroplasty: a multicenter study

OBJECTIVE

This multicenter study examined whether inpatient rehabilitation outcomes following total knee arthroplasty (TKA) were influenced by BMI.

METHODS AND PROCEDURES

This was a retrospective, comparative study conducted using a computerized medical database and medical records derived from TKA patients, at 15 independent rehabilitation hospitals (N = 5,428). Patients were separated into four groups based on BMI: non-obese (BMI < 25 kg/m(2)), overweight (25-29.9 kg/m(2)), moderately obese (30-40 kg/m(2)), severely obese (BMI > or = 40 kg/m(2)). All patients completed an interdisciplinary inpatient rehabilitation program post-TKA. Total and individual functional independence measure (FIM) scores, length of stay (LOS), FIM efficiency scores, itemized hospital charges, and discharge disposition location, were collected.

RESULTS

The percentage of total FIM change was 7.5% greater by the time of discharge in the non-obese than in the very severely obese (P < 0.05). FIM efficiency was lowest in the severely obese as compared to the remaining groups (3.7 points (pts)/day vs. 4.0-4.3 pts/day; P = 0.044). The change in the motor FIM score from admission to discharge was 6.7-15.6% greater in the non-obese than in the remaining groups (P < 0.05). The changes in cognition FIM, toilet transfer and walking without assistance scores were higher in the non-obese as compared to the severely obese group (P < 0.05). The severely obese group had higher total, physical and occupational therapy and pharmacy charges than the remaining groups (P < 0.05).

DISCUSSION

An excessive BMI does not prevent gains during inpatient rehabilitation; however, these gains are made less efficiently and at a higher cost than those made when the BMI is low.

Obesity profiles with knee osteoarthritis: correlation with pain, disability, disease progression

OBJECTIVES

To identify the prevalence of overweight among community-dwelling adults diagnosed as having knee osteoarthritis (OA) and the relationship between the weight status of these individuals, selected disease-related outcomes, and disease progression.

RESEARCH METHODS AND PROCEDURES

The BMIs of 82 women and 18 men with unilateral or bilateral knee OA were examined on a single occasion along with data on physical comorbidities, pain, and function and subjected to correlation analyses. BMIs from two additional samples, one that included 16 women with and without knee OA and one that included 24 women and 6 men with knee joint OA that required surgery for the subsequent onset of hip OA, were also assessed.

RESULTS

At least 80% of all present cohorts were overweight or obese. Those with higher BMIs reported more pain than those with lower BMIs (p<0.05) and pain was related to perceived physical exertion (p<0.05). Body mass indices were not significantly correlated with generic gait measures, but an inverse trend toward the time spent in the gait cycle (r=-0.63; p=0.097) that may impact the disease process was identified. Those with comorbidities had the same body mass, on average, as those with no comorbidities, and those with bilateral disease were heavier than those with unilateral disease.

DISCUSSION

A high body mass is present in most adults with knee OA. Moreover, being overweight may affect knee joint impact rates and pain incrementally. Having high body weights may heighten the risk for bilateral knee joint, as well as hip joint, OA.

Morbidity and mortality risk associated with an overweight BMI in older men and women

BACKGROUND

There is controversy as to whether older adults with a BMI in the overweight range (25 to 29.9 kg/m2) are at increased health risk and whether they should be encouraged to lose weight. The purpose of this study was to determine whether older adults with a BMI in the overweight range are at increased morbidity and mortality risk.

METHODS

Participants consisted of 4968 older (>or=65 years) men and women from the Cardiovascular Health Study limited access dataset. Based on BMI (kg/m2), participants were grouped into normal-weight (20 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2), and obese (>or=30 kg/m2) categories. Participants were followed for up to 9 years to determine if they developed 10 weight-related health outcomes that are pertinent to older adults. Cox proportional hazards models were used to estimate the hazards ratios of morbidity and mortality after adjusting for age, sex, income, smoking, and physical activity.

RESULTS

Compared with the normal-weight group, the risks of myocardial infarction, stroke, sleep apnea, urinary incontinence, cancer, and osteoporosis were not different in the overweight group (p>0.05). The risks for arthritis and physical disability were modestly increased in the overweight group (p<0.05), whereas the risk for type 2 diabetes was increased by 78% in the overweight group (p<0.01). After adjusting for all relevant covariates, all-cause mortality risk was 11% lower in the overweight group (p<0.05).

CONCLUSIONS

A BMI in the overweight range was associated with some modest disease risks but a slightly lower overall mortality rate. These findings suggest that a BMI cut-off point of 25 kg/m2 may be overly restrictive for the elderly.

Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial

OBJECTIVE

To evaluate the effects of tai chi consisting of group and home-based sessions in elderly subjects with knee osteoarthritis.

DESIGN

A randomized, controlled, single-blinded 12-week trial with stratification by age and sex, and six weeks of follow-up.

SETTING

General community.

PARTICIPANTS

Forty-one adults (70 +/- 9.2 years) with knee osteoarthritis.

INTERVENTIONS

The tai chi programme featured six weeks of group tai chi sessions, 40 min/session, three times a week, followed by another six weeks (weeks 7 -12) of home-based tai chi training. Subjects were requested to discontinue tai chi training during a six-week follow-up detraining period (weeks 13-18). Subjects in the attention control group attended six weeks of health lectures following the same schedule as the group-based tai chi intervention (weeks 0 -6), followed by 12 weeks of no activity (weeks 7-18).

MAIN OUTCOME MEASURES

Knee pain measured by visual analogue scale, knee range of motion and physical function measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were recorded at baseline and every three weeks throughout the 18-week study period. Data were analysed using a mixed model ANOVA.

RESULTS

The six weeks of group tai chi followed by another six weeks of home tai chi training showed significant improvements in mean overall knee pain (P = 0.0078), maximum knee pain (P = 0.0035) and the WOMAC subscales of physical function (P = 0.0075) and stiffness (P = 0.0206) compared to the baseline. No significant change of any outcome measure was noted in the attention control group throughout the study. The tai chi group reported lower overall pain and better WOMAC physical function than the attention control group at weeks 9 and 12. All improvements disappeared after detraining.

[Abdominal obesity and knee ostheoarthritis]

The objective of our study was to determine whether waist circumference (WC) is a more reliable indicator than body mass index (BMI) of the presence of knee osteoarthritis in obese subjects.

PATIENTS AND METHODS

We performed an observational study of obese patients with no other risk factors for knee osteoarthritis. For each patient, we evaluated BMI, WC, duration of obesity and knee pain. Two groups were identified: "asymptomatic patients" (AG), without knee pain, and "symptomatic patients" (SG). For the SG, we measured pain intensity (visual analog scale [VAS], 0-100 mm) and functional repercussions (using the Lequesne and WOMAC indexes). Patients with knee pain underwent standard radiographic procedures to search for signs of osteoarthritis, and the SG was divided into two subgroups: with radiological signs of osteoarthritis (SG-1) and without radiological signs of osteoarthritis (SG-2). The AG and SG groups and SG-1 and SG-2 groups were compared for age, sex, and duration of obesity. Comparisons of BMI, WC, and function involved the Student's t-test.

RESULTS

We recruited 56 patients for the study (82.5% females; mean obesity duration (13+/-6.5 years; mean age 43.21+/-9.58 years). The mean BMI was 39.6+/-7.23 kg/m(2) and mean WC was 113+/-14.3 cm. We found 33 patients (59%) with knee pain. Independent of age, sex, duration of obesity and BMI, the SG showed more significant WC (117.27+/-14.71 cm vs. 107+/-11.75 cm for the AG, P 0.01). In the same group and independent of the already mentioned factors, the patients with radiological signs of osteoarthritis showed significant WC [122+/-15.57 cm (SG-1) vs. 108+/-6.88 cm (SG-2) (P 0.01)]. Moreover, the VAS score of pain at rest and during effort and the WOMAC and Lequesne scores were 16+/-25.7 mm, 75+/-18.3 mm, 12.3+/-8.92 and 11.5+/-5.44 (SG-1) and 7+/-18.4 mm, 70+/-19.2 mm, 5.7+/-3.05, and 6.9+/-3.79 (SG-2), respectively. The difference between SG-1 and SG-2 was significant only for the WOMAC (P=0.015) and Lequesne (P=0.026) scores.

CONCLUSION

Independent of BMI, WC appears to be a factor associated with the presence of knee pain and osteoarthritis in obese patients. Furthermore, a high WC is associated with significant functional repercussion.

Effects of caloric restriction and a moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis

OBJECTIVE

To evaluate the effects of a weight reduction program combined with a basic or more complex physical therapy program including transcutaneous electric nerve stimulation on lameness in overweight dogs with osteoarthritis.

DESIGN

Nonblinded prospective randomized clinical trial. Animals-29 adult overweight or obese dogs with a body condition score of 4/5 or 5/5 and clinical and radiographic signs of osteoarthritis.

PROCEDURES

A weight-loss program was initiated for all dogs. One group received caloric restriction and a home-based physical therapy program. The other group received the identical dietetic protocol and an intensive physical therapy program including transcutaneous electrical nerve stimulation. Lameness was assessed clinically and by kinetic gait analysis on a treadmill with 4 force plates to measure symmetry of ground reaction forces (GRFs) of the affected and contralateral limbs in bimonthly intervals for 6 months.

RESULTS

Significant weight loss was achieved in both groups; however, greater weight reduction was attained by dogs treated with caloric restriction and intensive physiotherapy. Mobility and symmetry indices of GRFs were improved after 6 months; the best outcome was detected in the group receiving energy restriction combined with intensive physical therapy.

CONCLUSIONS AND CLINICAL RELEVANCE

Caloric restriction combined with intensive physical therapy improved mobility and facilitated weight loss in overweight dogs. The combination of dietetic and physical therapy may help to improve the health status more efficiently than dietetic treatment alone.

Factors affecting the outcome of arthroscopy in medial-compartment osteoarthritis of the knee

PURPOSE

This study was designed to obtain information on factors affecting the medium-term efficacy of arthroscopy (debridement or microfracturing of chondral defects) in patients with unicompartmental osteoarthritis (OA) of the knee.

METHODS

A total of 156 patients (71 men and 85 women; mean age, 51.6 +/- 8.7 years [range, 37 to 69 years]) with isolated Kellgren-Lawrence grade 2 medial-compartment knee OA underwent arthroscopy and were followed up. Patients with patellofemoral or lateral-compartment OA were excluded. The Knee Injury and Osteoarthritis Outcome Score was determined in all patients. The outcome was rated poor if this score was less than 114 points or if further surgery was required. Odds ratios (ORs) were calculated by use of multiple logistic regression adjusted for significantly associated factors.

RESULTS

Follow-up was performed in 92.9% of the patients, at a mean of 49.2 +/- 2.1 months (range, 47 to 54 months). The outcome was poor in 104 patients (71.7%). There were no gender differences. Factors significantly associated with a poor outcome were a history of OA for greater than 24 months (OR, 3.6), obesity (OR, 8.8), smoking (OR, 3.1), medial tibial osteophytes (OR, 5.4), medial joint space width on standing radiographs of less than 5 mm (OR, 7.3), absence of effusion (OR, 6.5), absence of synovitis (OR, 6.1), presence of crystal deposits (OR, 4.3), deep tibial cartilage defect (OR, 12.5), and need for subtotal or total meniscectomy (OR, 2.2). Patients with more than 4 of these factors had significantly poorer outcomes.

CONCLUSIONS

The medium-term outcome of arthroscopy in unicompartmental OA of the knee is poor in about 71.7% of the cases. In this study the outcome did not depend exclusively on the articular findings. Patient age was not associated with a poor outcome. However, a history of OA for more than 2 years, obesity, smoking, tibial osteophytes, and joint space narrowing of less 5 mm were associated with a poor outcome. Patients with 4 or more of these factors should be managed with treatment other than arthroscopy.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Separate and combined influence of body mass index and waist circumference on arthritis and knee osteoarthritis

OBJECTIVE

To determine if the combination of body mass index (BMI) and waist circumference (WC) explains an additional component of arthritis and knee osteoarthritis risk than is accounted for by either anthropometric measure alone.

DESIGN

Cross-sectional study.

PARTICIPANTS

Participants were part of the Third National Health and Nutrition Examination Survey, a representative sample of Americans conducted from 1988 to 1994. The arthritis analyses included 15 570 participants aged 18 years and older. The knee osteoarthritis analyses included 2323 participants aged 60 years and older. Body mass index and WC were measured in all participants and classified into sex-specific tertiles.

OUTCOME MEASURES

Arthritis (determined by self-report) and knee osteoarthritis (determined by radiograph).

RESULTS

Independent of sex, the likelihood of arthritis and knee osteoarthritis increased in a graded fashion when moving from the lowest to highest BMI tertile and when moving from the lowest to highest WC tertile (Ptrend < 0.01). In the next phase of analyses, subjects were divided into WC tertiles within each of the BMI tertiles. Within the lowest BMI tertile, the likelihood of arthritis and knee osteoarthritis was not different in the lowest, middle and highest WC tertiles (P > 0.1). Within the middle BMI tertile, the middle and high WC tertiles were more likely to have knee osteoarthritis compared to the lowest WC tertile (P < 0.05). Within the highest BMI tertile, the highest WC tertile was more likely to have arthritis and knee osteoarthritis compared to the lowest WC tertile (P < 0.05).

CONCLUSIONS

Both BMI and WC were strong predictors of arthritis and knee osteoarthritis. When a categorical approach was used for BMI and WC, similar to that in the clinical setting, independent effects of these anthropometric variables were observed.

Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results

OBJECTIVE

High tibial osteotomy (HTO) for the treatment of unicompartmental knee osteoarthritis in the presence of axial malalignment is recognized as an effective treatment for young and active patients. The aim of this study was to identify HTO prognostic factors.

METHODS

A total of 94 patients who had undergone HTO with additive arthroscopy were scored using the "knee injury and osteoarthritis outcome score" (KOOS). A KOOS of less than 114 points was judged as a poor outcome.

RESULTS

A total of 84 patients were available for follow-up after a time-interval of 45.9+/-7.6 (range 34-60) months. The KOOS increased from 46.1+/-11.1 to 120.3+/-40.8. The preoperative varus angle in all patients was 7.5 degrees +/-1.9 (range 5-14 degrees ). In follow-up the patients had a mean valgus angle of 3.7 degrees +/-2.5. Twenty-three patients (27.4%) had suffered a loss of correction (0.8 degrees , range 0-2 degrees ). A loss of correction correlated with a minor result in tendency. A total of 25 patients (29.8%) had a poor KOOS. Factors associated with a poor HTO outcome were a patient history of more than 24 months, a preoperative KOOS>50 points, obesity, and smoking. However, the results were also influenced by radiological findings, such as medial tibial exophyte, a medial joint space width of less than 5mm, and intraarticular damage, such as a degree IV cartilage defect of the tibia. Gender was also a minor prognostic factor. Patient's age and the event of prior surgery did not influence the outcome.

CONCLUSION

This study identified relevant factors that significantly influenced HTO results. It was possible to create a "predictive score" for HTO patients. Patients with more than 4 of the poor prognostic factors should chose primary arthroplasty.