Hamdi Amre, Albaghdadi Alia T, Ghalimah Bayan, Alnowiser Abdullah, Ahmad Anas, Altaf Abdulmalik
Department of Orthopedic Surgery, Faculty of Medicine, King Abdulaziz University, P.O Box 80215, 21589, Jeddah, Kingdom of Saudi Arabia.
Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
J Orthop Surg Res. 2018 Apr 11;13(1):82. doi: 10.1186/s13018-018-0803-4.
Obesity remains the strongest predictor of knee osteoarthritis (OA). Studies have reported improvement in knee pain and function post-bariatric surgery secondary to weight loss and reduced mechanical loading, yet others found increased rates of total knee arthroplasty (TKA) in that patient population. To address this controversy, our study aimed to further assess the effect of surgically induced, "rapid" weight loss on knee pain and function.
Obese patients with chronic knee pain, who were undergoing bariatric surgery, were enrolled and surveyed preoperatively and 3 months postoperatively. Our outcome measures were knee pain and knee function, assessed by a knee injury and osteoarthritis outcome score (KOOS). The paired t test was used to compare pre- and postoperative KOOS scores. Pearson correlation coefficient was used to test the correlation between change in body mass index (BMI) with knee function, pain, and stiffness.
A total of 30 patients was included in the study. The mean age was 35 years, with a mean preoperative BMI of 42.8. The mean difference in BMI at 3 months was 8.4 (SD3). There was a significant improvement in KOOS, - 23.2 (± 20) points, p < 0.01, most pronounced in knee function related to sport activities, with a difference of - 22.6 points, p < 0.01. Knee pain scores improved but did not reach statistical significance.
Surgically induced rapid weight loss significantly improved knee function, particularly related to sports. However, there was no change in knee pain. This may be related to increased high-impact knee exercises and reduced lean mass. Tailored exercise programs for bariatric surgery patients postoperatively, may improve symptoms and decrease the need for knee replacements in the long term.
肥胖仍然是膝关节骨关节炎（OA）最强的预测因素。研究报告称，减肥手术后，由于体重减轻和机械负荷降低，膝关节疼痛和功能有所改善，但也有其他研究发现该患者群体中全膝关节置换术（TKA）的发生率增加。为了解决这一争议，我们的研究旨在进一步评估手术诱导的“快速”体重减轻对膝关节疼痛和功能的影响。
纳入接受减肥手术的慢性膝关节疼痛肥胖患者，在术前和术后3个月进行调查。我们的结局指标是膝关节疼痛和膝关节功能，通过膝关节损伤和骨关节炎结局评分（KOOS）进行评估。采用配对t检验比较术前和术后的KOOS评分。使用Pearson相关系数检验体重指数（BMI）变化与膝关节功能、疼痛和僵硬之间的相关性。
本研究共纳入30例患者。平均年龄为35岁，术前平均BMI为42.8。3个月时BMI的平均差异为8.4（标准差3）。KOOS有显著改善，提高了-23.2（±20）分，p<0.01，在与体育活动相关的膝关节功能方面最为明显，差异为-22.6分，p<0.01。膝关节疼痛评分有所改善，但未达到统计学意义。
手术诱导的快速体重减轻显著改善了膝关节功能，尤其是与运动相关的功能。然而，膝关节疼痛没有变化。这可能与高强度膝关节运动增加和瘦体重减少有关。为减肥手术患者术后量身定制运动计划，可能会改善症状，并减少长期膝关节置换的需求。
