What is osteoarthritis?
Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage). In a person with osteoarthritis, the cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the affected joint. This condition most commonly affects the joints in hips, knees, hands, and spine. Osteoarthritis is a leading cause of pain and disability for the Australian population particularly in the elderly.
What are the causes and risk factors for osteoarthritis?
Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to being overweight, excessive strain over prolonged periods of time, previous fracture, growth abnormalities, joint diseases, injury or deformity.
Some people have congenital abnormalities of the joints that cause early degeneration and subsequently cause osteoarthritis.
How do you diagnose this?
Doctors diagnose osteoarthritis with a medical history, physical exam and x-rays of the affected joint. During the physical examination your doctor will examine the affected joint for swelling, pain, tenderness, and assess the joint’s range of motion. An X-ray of the knee may show a loss of the joint space and bone spur formation.
There is no blood test for osteoarthritis.
How is osteoarthritis managed?
There is no known cure for osteoarthritis; however, there are several treatments and lifestyle modifications that can help you ease your pain and symptoms. The objective of the treatment is to reduce pain, improve joint movement, and prevent further damage to joint. The treatment of osteoarthritis involves:
- Medications: Medications may include different classes such as paracetamol, anti-inflammatory drugs, steroid injections, artificial joint fluid injections, and other drugs.
- Lifestyle modifications:
Some of the lifestyle modifications include:
- A moderate exercise program
- Use of Heat or cold treatments
- Eating a healthy and well-balanced diet
- Get adequate rest
- Lose weight
- Protect your joints with the use of assistive devices such as splints or braces to support the weakened joints
- Physical therapy: Your physical therapist will teach you exercises to keep joints flexible and improve muscle strength.
- Surgery: Surgery is usually considered if nonsurgical treatment fails to provide relief. Joint replacement surgery is considered as an option when the pain is so severe that it affects your ability to carry out normal activities.
Obesity, Weight Loss, and Joint Replacement Surgery
If you need total knee or total hip replacement surgery—and your weight is significantly higher than it should be—your doctor may advise you to lose weight before your procedure. Even though you may feel fit and healthy at your current weight, studies show that a patient with a BMI greater than 40 is more likely to experience serious complications both during and after surgery than a patient of normal weight. Your doctor wants you to be aware of these risks so that you can take steps to minimize them before your procedure.
What is BMI?
BMI is a measure of body fat based on height and weight. Typically, the higher your BMI, the more body fat you have. Your doctor will use the following calculation to determine your BMI:
BMI = weight (kg) / height (m)2
For an adult, the following BMI ranges apply:
BMI Ranges Weight Status
- 18 to 24 - Normal
- 25 to 29 - Overweight
- 30 to 39 - Obese
- 40 to 49 - Morbidly obese
What health conditions may impact my surgery?
Patients with obesity are more likely to have certain diseases and health conditions that increase the risks of surgery. These include:
- Cardiovascular disease, including high blood pressure
- Type 2 diabetes
- Obstructive sleep apnea
- Metabolic syndrome—a group of health conditions that increase your risk for developing cardiovascular disease and type 2 diabetes
Metabolic syndrome-a group of health conditions that increase your risk for developing cardiovascular disease and type 2 diabetes
It is important to be in the best health possible before your surgery. If you have one of these conditions, your doctor will work with you to ensure that it is managed and under control before your procedure.
Is there an increased risk of complications due to my weight?
There are risks associated with every surgery. However, some risks are greater for patients with obesity.
What extra challenges do overweight patients present during surgery?
Anesthesia. It is more difficult to administer anesthesia to a patient with obesity. Complications may be due to the patient’s body shape and anatomy, or to health conditions that can affect breathing. Challenges for the anesthesiologist include:
- Locating veins to administer general anesthesia and necessary medications
- Ensuring that oxygen and airflow are sufficient
- Properly positioning the needle when delivering spinal and epidural nerve blocks and other types of regional anesthesia
Operative times. There are technical challenges associated with performing surgery on a patient with obesity, so operative times are often longer. In general, the longer you are in surgery, the greater your risk of experiencing complications.
What are some common complications obese patients may encounter?
Compared with a patient of normal weight, a patient with obesity is more likely to experience the following complications after surgery:
- Poor wound healing
- Difficulty breathing
- Blood clots
- Pulmonary embolism - a blood clot in the lungs
Are there lesser outcomes after joint replacement due to obesity?
Joint replacement will help relieve your pain and enable you to live a fuller, more active life. However, if you have obesity, you may never achieve the increased mobility and range of motion experienced by a patient of normal weight.
You may also experience more implant and prosthesis complications after surgery, including:
- Component loosening and failure
- Dislocation of the replacement joint, especially in the hip
In some cases, a second “revision” surgery may be necessary to remove failed implants and replace them with new ones.
How may I reduce my risks?
In most cases, total hip and total knee replacement are elective procedures. For this reason, your doctor may recommend that you try nonsurgical treatments—such as medications and physical therapy—in order to delay your joint replacement surgery. This will give you time to lose weight and reduce your BMI before your procedure.
The key elements to losing weight are diet and exercise. In general, you should try to make the following lifestyle changes:
- Reduce your fat and calorie intake. Try to eat meals that are full of fruits, vegetables and whole grains, lean meats, and low-fat dairy. Drink plenty of water and avoid sugary drinks that are high in calories.
Get more physical activity and exercise. If you have constant hip or knee pain, you may not be as active as you were before. Low-impact activities-such as swimming, biking, or using an elliptical machine-will put less strain on your joints than strenuous exercise and will still be effective in helping you lose weight.
Make a Change Now
Patients who need joint replacement surgery often intend to lose weight after their procedure—when their relief from pain will enable them to be more physically active.
In reality, however, studies show that just a small percentage of patients with obesity actually lose weight after joint replacement—the majority of patients maintain the same BMI after surgery.
Rather than waiting, there is great value in establishing a healthier lifestyle now—before your joint replacement surgery. Losing weight and reducing your BMI will decrease your risk for complications and increase the likelihood of a successful surgical outcome. In some cases, it may also decrease your pain to the point where joint replacement may no longer be needed—or can be put off for a number of years.