New Research on Weight Loss and Knee Pain

There is a debate going on between doctors, surgeons and health care providers as to the role of weight loss in managing knee pain . . .

In December 2017, a study from the United Kingdom in the European Journal of orthopaedic surgery & traumatology found surgeons at odds with each other.

Investigators sent a survey to surgeon members of the British Association for Surgery of the Knee. The purpose was to explore knee surgeons’ opinions and practices regarding the management of painful knees in obese patients.

The survey showed considerable practice variation and divided opinion on the scientific evidence.

The slight majority of surgeons stated that weight loss should be the first-line treatment, 53% and this should ideally be managed by a specialist multidisciplinary service. However, only 24% of the surgeons would be interested in being the orthopaedic surgeon in such a multidisciplinary service.(1)

Half of surgeons in this study think people should lose weight. One in 4 want to be part of a program.

For many, weight loss is not part of the surgical program

At the Magaziner Center knee pain is treated with a holistic approach including helping patients lose weight. Weight loss, as you will see in the research below is an important part of healing.

A May 2017 study lead by Alexandra Gersing, MD of the Department of Radiology and Biomedical Imaging at the University of California, San Francisco concluded that overweight and obese people who lost a substantial amount of weight over a 48-month period showed significantly lower degeneration of their knee cartilage. The research was published in the medical journal Radiology.(2)

“The most exciting finding of our research was that not only did we see slower degeneration in the articular cartilage, we saw that the menisci degenerated a lot slower in overweight and obese individuals who lost more than 5 percent of their body weight and that the effects were strongest in overweight individuals and in individuals with substantial weight loss,” Dr. Gersing said.

This study was a continuation of Dr. Gersing’s work on the subject. In 2o16 she lead a team of researchers who were able to suggest from findings that: “weight loss has a protective effect on cartilage, which is detected in all (knee) compartments, and that a larger amount of weight loss is more beneficial in obese and overweight subjects in order to slow progression of cartilage matrix deterioration and worsening of clinical symptoms.”(3)

It is not easy to lose weight

Researchers recognize the “catch-22 effect” in knee osteoarthritis patients who battle obesity. The knee pain makes them inactive which leads to weight gain and the weight gain leads to greater pain in the knee. The greater pain in the knee is caused by heightening of chronic inflammation. Chronic inflammation in the knee leads to bone and soft tissue destruction. While we present the research, it should be obvious that weight and knee pain are related.

From Northwestern University: “Being obese or overweight, the quality of the diet, severe pain, and severe dysfunction are significantly associated with physical inactivity in adults with knee osteoarthritis.” (4)
Doctors at Duke University School of Medicine say that treatment plans that reduce pain, manage pain with appropriate coping skills and lifestyle behavioral weight management can modify the inflammatory state (reduce inflammation) and lead to more successful treatment and weight reduction.(5)

The holistic approach weight loss, hormones, knee pain

Doctors at Monash University in Australia examined whether concentrations of circulating sex steroid hormones in overweight and obese men were associated with higher risk of primary knee and hip arthroplasty (replacement). The answer: Yes, low plasma androstenedione (testosterone) concentration is associated with an increased risk of both knee and hip arthroplasty for osteoarthritis in overweight and obese men. (6)

How much of quality life is lost to patients with knee pain? To obesity? To a combination of knee pain and obesity?

Researchers writing in the Annals of Internal Medicine sought to answer these questions. They looked at subjects between the ages of 50 and 84 and sought to estimate quality-adjusted life-years lost due to obesity and knee osteoarthritis and health benefits of reducing obesity prevalence to levels observed in the 1990’s when obesity was much less prevalent.

Here is what they found: Non-obese patients with knee pain from osteoarthritis – almost 1.9 years quality life-years lost. For patients with both osteoarthritis knee pain and obesity 3.5 years of quality life lost.
Amazingly the researchers found that if physicians tackled the problems of obesity in osteoarthritis knee pain “findings suggested that reversing obesity prevalence to levels seen 10 years ago would avert 178,071 cases of coronary heart disease, 889,872 cases of diabetes, and 111,206 total knee replacements.”(7)

Recent research from American and Australian doctors is significant. The researchers examined more than 1300 patients over the age of 64 who were suffering from knee pain and obesity. What the doctors were looking for was for the effects of weight loss on the joint pain of the study subjects. The effects were significant.

Even a weight loss of 2.5% meaning 5 pounds on a 200-pound frame showed significant improvement in pain.(8)

Despite the benefits, weight loss is difficult to achieve.

Despite these findings, the researchers had to also conclude that even desiring and attempting to lose weight, obese people with symptomatic knee osteoarthritis more commonly reported weight gain.

At the Magaziner Center for Wellness, we take a holistic view of the body, even from an orthopaedic standpoint. We believe it is crucial to obtain recovery from an injury or to cure chronic pain; Stem Cell Injections, PRP and Prolotherapy cannot be given just into that injured joint. We need to look at joints above and below the injury and make sure they are stable. If these areas are left unstable, and not treated, then the original injury has a greater chance to recur.

We bring a comprehensive understanding of thyroid, hormonal, metabolic and nutritional medicine to our treatment of our patients. Since regular exercise and a healthy diet are crucial when it comes to controlling weight, we speak to each patient about his or her lifestyle habits, as well as his or her biochemistry, in order to create a customized treatment plan.

For the long run, we help our patients understand food choices and their impact on the body. Our goal is to help our patients maintain their weight loss for a lifetime, by educating them on proper nutrition and changing body chemistry to reduce cravings.

Do you have questions about knee pain, testosterone, and weight management? Contact us!

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REFERENCES

1 Hill DS, Freudmann M, Sergeant JC, Board T. Management of symptomatic knee osteoarthritis in obesity: a survey of orthopaedic surgeons’ opinions and practice. European Journal of Orthopaedic Surgery & Traumatology. 2017 Dec 28:1-8.

2 Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Chanchek N, Guimaraes JB, Mbapte Wamba J, Facchetti L, McCulloch CE, Link TM. Is weight loss associated with less progression of changes in knee articular cartilage among obese and overweight patients as assessed with MR imaging over 48 months? Data from the Osteoarthritis Initiative. Radiology. 2017 May 2;284(2):508-20.

3 Gersing AS, Solka M, Joseph GB, et al. Progression of Cartilage Degeneration and Clinical Symptoms in Obese and Overweight Individuals is Dependent on the Amount of Weight Loss: 48-Month Data from the Osteoarthritis Initiative. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 2016;24(7):1126-1134. doi:10.1016/j.joca.2016.01.984.

4 Lee J, Song J, Hootman JM, et al. Obesity and Other Modifiable Factors for Physical Inactivity Measured by Accelerometer in Adults with Knee Osteoarthritis: Data from the Osteoarthritis Initiative (OAI). Arthritis care & research. 2013;65(1):53-61. doi:10.1002/acr.21754.

5. Huebner JL, Landerman LR, Somers TJ, Keefe FJ, Guilak F, Blumenthal JA, Caldwell DS, Kraus VB. Exploratory Secondary Analyses of a Cognitive-Behavioral Intervention for Knee Osteoarthritis Demonstrate Reduction in Biomarkers of Adipocyte Inflammation. Osteoarthritis Cartilage. 2016 Apr 15. pii: S1063-4584(16)30015-2. doi: 10.1016/j.joca.2016.04.002.

6 Hussain SM, Cicuttini FM, Giles GG, Graves SE, Wang Y. Relationship between circulating sex steroid hormone concentrations and incidence of total knee and hip arthroplasty due to osteoarthritis in men. Osteoarthritis Cartilage. 2016 Apr 12. pii: S1063-4584(16)30024-3. doi: 10.1016/j.joca.2016.04.008.

7 Losina E, Walensky RP, Reichmann WM. Impact of obesity and knee osteoarthritis on morbidity and mortality in older Americans. Ann Intern Med. 2011 Feb 15;154(4):217-26.

8 Atukorala I, Makovey J, Lawler L, Messier SP, Bennell K, Hunter DJ. Is there a dose response relationship between weight loss and symptom improvement in persons with knee osteoarthritis? Arthritis Care Res (Hoboken). 2016 Jan 19. doi: 10.1002/acr.22805.