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Mabrouk A, Risebury M, Yasen S. Medial opening wedge high tibial osteotomy performs similarly irrespective of body mass index. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38932608 DOI: 10.1002/ksa.12317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE This study investigates the effect of the body mass index (BMI) on the early (2 years) to midterm (5 years) results of medial opening wedge high tibial osteotomy (MOWHTO). METHODS A prospectively maintained single-centre database of 1138 knee osteotomies, between 2002 and 2022, was retrospectively reviewed. Adult patients who underwent MOWHTO for symptomatic unicompartmental medial knee osteoarthritis (OA), with varus knee malalignment, having failed conservative management, were included. Patients were categorized into three groups according to their BMI as per the classification from the National Institute for Health and Care Excellence (NICE): the healthy weight (HW) group (BMI of 18.5-24.9 kg/m2), the overweight (OW) (BMI of 25-29.9 kg/m2), and the obesity (OB) group (BMI ≥ 30 kg/m2). Multiple patient-reported outcome measures (n = 6) were recorded preoperatively and at 2 and 5 years postoperatively. Deformity analysis was undertaken preoperatively and postoperatively. The relative risk (RR) of the complications between the HW, OW and OB groups was calculated. The rate of conversion to arthroplasty, and 5 and 10 years survivorship were recorded, as well as the hazard ratio (HR) of BMI on survivorship. RESULTS A total of 574 cases were included in the study: the HW group (n = 96), the OW group (n = 233) and the OB group (n = 245), with a mean BMI of 23 ± 1.5 kg/m2, 27.4 ± 1.4 kg/m2 and 34.4 ± 3.8 kg/m2, respectively. The mean follow-up was 13.3 years (4.8-20.3). The mean mechanical tibiofemoral angle corrections were in the HW group: 7.1 ± 3°, OW group: 6.6 ± 3.5° and OB group: 7.1 ± 3.8°, with no intergroup significant difference (p = n.s.). Clinically, despite lower preoperative scores in the OW and OB groups, no difference was observed postoperatively amongst the three groups. The overall complication rate was 12.5% in the HW group, 6.8% in the OW group, and 9.8% in the OB group. There was no significant difference in the RR of complications between the HW and OW groups (RR = 0.6, 95% confidence interval [CI] = 0.3-1.3) (p = 0.2), and the HW and OB groups (RR = 0.8; 95% CI = 0.3-2.2) (p = 0.7). There was no overall significant difference in survival outcomes based on the BMI between the three groups (p = 0.4). The HR of conversion to arthroplasty between the HW and OW groups was 1.4 [95% CI = 0.6-3.5](p = 0.5) and between the HW and OB groups was 1.8 [95% CI = 0.8-4.4] (p = 0.2). CONCLUSION BMI has no significant effect on either the radiological corrections, clinical outcomes, complications or survivorship of MOWHTO at short- to medium-term follow-up. No specific cutoff point for BMI can be recommended as a contraindication to MOWHTO. LEVEL OF EVIDENCE Level IV, Retrospective cohort study.
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Affiliation(s)
- Ahmed Mabrouk
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Michael Risebury
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Sam Yasen
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Harris C, Nadeem F, Hargreaves M, Campbell C, Momaya A, Casp A. Obesity does not impact complications and conversion to total knee arthroplasty after high tibial osteotomy: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:666-677. [PMID: 38410034 DOI: 10.1002/ksa.12084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE The purpose of this systematic review is to consolidate outcomes of obese patients undergoing high tibial osteotomy and to investigate the effect of obesity on postoperative outcomes, including symptomatic relief and time to conversion to arthroplasty. METHODS Medline, Embase and Cochrane Library were searched from database inception up to April 2023 according to PRISMA guidelines by two reviewers. Search terms including 'obesity', 'BMI', 'osteotomy' and 'high tibial osteotomy (HTO)' were included to identify all relevant articles. Only studies that explicitly reported outcomes for obese patients were included. Disagreements in study inclusion or quality assessment were resolved by a senior third reviewer. Metrics compared include time to arthroplasty, preoperative and postoperative mechanical tibiofemoral angle (mTFA), patient-reported satisfaction scores and postoperative complications. RESULTS Nine studies comparing 973 patients were included. The mean age was 52.7 ± 4.2 years old and 38.4% were male. Six studies performed the medial opening-wedge HTO, and three utilized the medial wedge closing technique. Most studies indicated significant improvement following surgical intervention with satisfactory outcomes in obese and nonobese patients. In addition, differences in complication rates were minimal between obese and nonobese patients (n.s.), while functional scores did not vary significantly. Conversion to total knee arthroplasty was not found to increase in obese patients (n.s.). CONCLUSION Obesity does not appear to carry a greater complication risk or worse outcomes following high tibial osteotomies, and surgeons should consider HTO a viable option for young obese patients with symptomatic unicompartmental chondral wear with coronal limb malalignment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chandler Harris
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Fahad Nadeem
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Mathew Hargreaves
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Collier Campbell
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amit Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aaron Casp
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Cale F, Genet F, Rougereau G. New Distal femoral osteotomy technique for adult patients with major epiphyseal valgus dysplasia. J Clin Orthop Trauma 2023; 40:102167. [PMID: 37273766 PMCID: PMC10238761 DOI: 10.1016/j.jcot.2023.102167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/27/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2023] Open
Abstract
The management of constitutional knee deformities may be a challenge. In most cases, the deformities are limited and accessible to conventional osteotomy techniques. This case reports an adult with extreme epiphyseal dysplasia of both distal femurs, and its management by a new osteotomy technique. At the last follow-up, 2.8 years after the previous surgery, the patient was walking without limitation or pain, and all osteotomies were healed. He had a Knee Society Score (KSS) of 57 and a functional KSS score of 100.
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Affiliation(s)
- Fabien Cale
- Department of Orthopedic Surgery, Raymond Poincaré Hospital, 104 BD Raymond Poincaré, 92380, Garches, France
| | - François Genet
- Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, 104 BD Raymond Poincaré, 92380, Garches, France
| | - Grégoire Rougereau
- Department of Orthopedic Surgery, Raymond Poincaré Hospital, 104 BD Raymond Poincaré, 92380, Garches, France
- Department of Orthopedics and Traumatology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
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Cheng HY, Liang CW, Chu CL, Hsu HW, Hou SM, Shih KS. Using multivariate nonlinear mixed-effects model to investigate factors influencing symptom improvement after high tibial osteotomy in combination with bone marrow concentrate injection for medial compartment knee osteoarthritis: a prospective, open-label study. BMC Musculoskelet Disord 2023; 24:208. [PMID: 36941604 PMCID: PMC10026441 DOI: 10.1186/s12891-023-06314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/11/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE To investigate the effects of various demographic, structural, radiographic, and clinical factors on the prognosis of patients with medial compartmental knee osteoarthritis with varus deformity undergoing medial opening wedge high tibial osteotomy (HTO) in combination with bone marrow concentrate (BMC) injection. METHODS In this prospective study, 20 patients underwent medial opening wedge HTO in combination with BMC injection with 12 months of follow-up. The structural and radiographic outcomes were evaluated by femorotibial angle and posterior tibial slope angle. The clinical outcomes were evaluated by visual analogue scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and The Knee injury and Osteoarthritis Outcome Score (KOOS). Multivariate nonlinear mixed-effects models with asymptotic regressions were used to model the trajectory of symptom improvement. RESULTS Medial opening wedge HTO in combination with BMC corrected the malalignment of the knee and led to significant symptom relief. The improvement of clinical symptoms reached a plateau 6 months after the surgery. Greater symptom severity at baseline and lower Kellgren-Lawrance (KL) grades were correlated with better post-operative clinical outcomes. Body-Mass-Index (BMI), femorotibial angle, age, and sex may also play a role in influencing the extent of symptom relief. CONCLUSION Symptom severity at baseline is important for prognosis prediction. In clinical practice, we suggest that the evaluation of clinical features and functional status of the patients be more emphasised.
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Affiliation(s)
- Hsiao-Yi Cheng
- Department of Primary Care Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Wei Liang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Lun Chu
- Department of Orthopaedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Hao-Wei Hsu
- Department of Orthopaedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Sheng-Mou Hou
- Department of Orthopaedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Kao-Shang Shih
- Department of Orthopaedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
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Huang L, Xu Y, Wei L, Yuan G, Chen W, Gao S, Liu W, Tan Z, Zhao J. Unicompartmental knee arthroplasty is superior to high tibial osteotomy for the treatment of medial unicompartmental osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29576. [PMID: 35905249 PMCID: PMC9333480 DOI: 10.1097/md.0000000000029576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are widely used for the treatment of medial unicompartmental knee osteoarthritis (OA). However, the best approach remains controversial. This study aimed to present a systematic review and a meta-analysis to directly compare the clinical outcomes between HTO and UKA. We hypothesized that the clinical outcomes after UKA and HTO would be similar. METHODS Electronic databases (Web of Science, PubMed, Embase, CENTRAL, and Biosis Preview) were searched for related studies published before November 30, 2021. Retrospective and prospective studies that directly compared the postoperative outcomes between UKA and HTO were included. Odds ratio (ORs) and 95% confidence interval (CIs) for complications, revision to total knee arthroplasty (TKA), and weighted mean difference (MD) and 95% CIs in range of motion (ROM), pain, walking speed and function score were evaluated. Two reviewers independently assessed the quality of the studies. Subgroup and sensitivity analyses were performed to explore the heterogeneity. RESULTS Twenty-three retrospective and 6 prospective studies were included. A total of 3004 patients (3084 knees) were evaluated for comparison. Complications (OR, 4.88, 95% CI: 2.92-6.86) were significantly greater in the HTO group than in the UKA group. Postoperative function scores including Lysholm score (MD, -2.78, 95% CI: -5.37 to -0.18) and Hospital for Special Surgery (HSS) score (MD, -2.80, 95% CI: -5.39 to -0.20) were significantly lower in the HTO group than the UKA group. The postoperative ROM was similar between HTO and mobile-bearing UKA (MD, -3.78, 95% CI: -15.78 to 8.22). However, no significant differences were observed between the HTO and UKA group in terms of postoperative pain, walking speed, and revision to TKA. CONCLUSIONS UKA is superior to HTO in minimizing complications and enhancing postoperative function scores. Mobile-bearing UKA has a similar ROM compared with HTO. Both HTO and UKA provide satisfactory clinical outcomes in terms of walking speed, relieving pain, and revision to TKA. UKA appears to be more suitable for the elderly, and both mobile-bearing UKA and HTO are viable surgical options for younger active individuals.
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Affiliation(s)
- Linke Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Yinglong Xu
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- Department of Orthopaedics, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Linhua Wei
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- The Affiliated Nanning Infectious Disease Hospital of Guangxi Medical University, The Fourth People’s Hospital of Nanning, Nanning, GuangxiChina
| | - Guangzhi Yuan
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Weiwei Chen
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, GuangxiChina
| | - Shiyao Gao
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Wei Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Zhen Tan
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Jinmin Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- * Correspondence: Jinmin Zhao MD, Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi, China (e-mail: )
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Yuan L, Niu S, Zhai C, Li S, Bian J, Zhao X, Zhang Y, Wang G. Influence of lower-limb mechanical axis on the curative effect of medial high tibial osteotomy for knee osteoarthritis. BMC Surg 2022; 22:177. [PMID: 35562799 PMCID: PMC9107279 DOI: 10.1186/s12893-022-01629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the effect of the ratio of the medial tibial plateau width to the total tibial plateau width on the therapeutic efficacy of high tibial osteotomy (HTO) on the medial side for the treatment of knee osteoarthritis. METHODS In this study, we retrospectively analyzed information of 278 patients who underwent medial HTO for knee osteoarthritis with varus deformity. The Tinetti Gait and Balance Assessment Tool, the Visual Analog Scale (VAS), and the Knee Society Scoring System (KSS) were used to comprehensively evaluate the function of the knee joint after HTO. RESULTS After adjusting for potential confounding factors (i.e., age, gender, body mass index/BMI, and surgical site), the Tinetti assessment score was optimized when the degree of correction was 53.67%, with the β-value on the left and right sides of the inflection point of 0.49 (confidence interval, CI: 0.20, 0.78, P = 0.0009) and- 0.26 (95% CI: - 0.30, - 0.22, P < 0.0001), respectively. The KSS score was optimized when the degree of correction was 55.45%, with the β-value on the left and right sides of the inflection point of 2.77 (95% CI: 1.64, 3.90, P < 0.0001) and - 1.18 (95% CI: - 1.46, - 0.91, P < 0.0001), respectively. The VAS score was the lowest when the degree of correction was 55.00%, with the β-value on the left and right sides of the inflection point of - 0.16 (95% CI: - 0.29, - 0.03, P = 0.0146) and 0.08 (95% CI: 0.05, 0.10, P < 0.0001), respectively. Stratified analysis showed that the BMI affected the Tinetti assessment score (β = - 0.14, 95% CI: - 0.24, - 0.04, P = 0.0071). According to the smooth-curve fitting results, when the BMI was > 28, the Tinetti assessment score showed a negative trend. CONCLUSION The degree of lower-limb mechanical axis correction correlated with the functional status of the knee joint after MOW HTO. When the ratio of the medial tibial plateau width to the total tibial plateau width was approximately 55%, the post-MOW HTO outcomes were optimized and the patients experienced the highest satisfaction. In addition, very high BMI was not conducive for the postoperative recovery of the knee joint function. LEVEL OF EVIDENCE III Case-control study/Retrospective comparative study.
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Affiliation(s)
- Long Yuan
- Department of Clinical, Jining Medical University, Jining, Shandong, China
| | - Shuaishuai Niu
- Department of Orthopedics and Joints, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Chuanxing Zhai
- Department of Clinical, Jining Medical University, Jining, Shandong, China
| | - Sen Li
- Department of Clinical, Jining Medical University, Jining, Shandong, China
| | - Jichao Bian
- Department of Clinical, Jining Medical University, Jining, Shandong, China
| | - Xiaowei Zhao
- Department of Orthopedics and Joints, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yuanmin Zhang
- Department of Orthopedics and Joints, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Guodong Wang
- Department of Orthopedics and Joints, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
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Ziqi Z, Yufeng M, Lei Z, Chunsheng W, Pei Y, Kunzheng W. Therapeutic Effects Comparison and Revision Case Analysis of Unicompartmental Knee Arthroplasty and Open Wedge High Tibial Osteotomy in Treating Medial Knee Osteoarthritis in Patients Under 60 years: A 2-6-year Follow-up Study. Orthop Surg 2020; 12:1635-1643. [PMID: 32893481 PMCID: PMC7767766 DOI: 10.1111/os.12761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the therapeutic effects and revision cases of unicompartmental knee arthroplasty (UKA) and open wedge high tibial osteotomy (OWHTO) in treating medial knee osteoarthritis (MKOA) in patients under 60 years. Methods The present retrospective study included a total of 192 patients who were diagnosed with MKOA and treated by UKA or OWHTO in the Second Affiliated hospital of Xi'an Jiaotong University and Xi'an Honghui Hospital between December 2012 and December 2016. Among these patients, 83 were treated by UKA (17 men and 66 women, aged 53.7 ± 5.2 years) and 109 were treated by OWHTO (23 men and 86 women, aged 51.8 ± 6.9 years). Patients were followed up at 1, 3, 6, and 12 months for the first year postoperation, and every 6 months from the second year postoperation. Basic data, perioperative data, hospital for special surgery (HSS) score, visual analogue pain score (VAS), low‐impact recovery, and revision cases of the patients were evaluated. Results The average follow‐up periods of the UKA group and the OWHTO group were 39.3 ± 11.2 months and 40.2 ± 13.5 months, respectively. No significant difference was found in the basic data of the two groups (P ≥ 0.05). The operative time, incision length, and dominant blood loss of the UKA group was less than those of OWHTO group by 19.6%, 10.7%, and 35.1%, respectively, and the differences were significant (P < 0.05), while no significant difference was found in postoperative in‐bed time (P ≥ 0.05). The HSS scores of the UKA group at 1 and 3 months postoperation were higher than those of the OWHTO group by 5.1% and 3.9% (P < 0.05), while no differences were found from 6 months postoperation (P ≥ 0.05). The VAS score of the UKA group 1 month postoperation was lower than that of the OWHTO group by 12.2% (P < 0.05), while no differences were found from 3 months postoperation (P ≥ 0.05). One year after the operation, most patients in both groups could not achieve ideal recovery in low‐impact sports, and no significant differences were found (P < 0.05). The sport in which most patients could not achieve ideal recovery was mountain climbing. No revision cases occurred in the OWHTO group, while two revisions occurred in the UKA group. Conclusion Candidates for UKA should be chosen carefully and the current indications and contraindications raised by Goodfellow should be modified.
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Affiliation(s)
- Zhang Ziqi
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Mei Yufeng
- Department of Rheumatology and Immune Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhang Lei
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Wang Chunsheng
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Yang Pei
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Wang Kunzheng
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
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Chen L, Zheng JJY, Li G, Yuan J, Ebert JR, Li H, Papadimitriou J, Wang Q, Wood D, Jones CW, Zheng M. Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading. J Orthop Translat 2020; 24:66-75. [PMID: 32695606 PMCID: PMC7349942 DOI: 10.1016/j.jot.2020.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 12/16/2022] Open
Abstract
Obesity-related osteoarthritis (OA) is a complex, multifactorial condition that can cause significant impact on patients' quality of life. Whilst chronic inflammation, adipocytokines and metabolic factors are considered to be important pathogenic factors in obesity related OA, there has been limited investigation into the biomechanical impact of obesity on OA development. This review aims to demonstrate that mechanical factors are the major pathological cause of obesity-related OA. The effect of obesity on pathological changes to the osteochondral unit and surrounding connective tissues in OA is summarized, as well as the impact of obesity-related excessive and abnormal joint loading, concomitant joint malalignment and muscle weakness. An integrated therapeutic strategy based on this multi-factorial presentation is presented, to assist in the management of obesity related OA. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE Despite the high prevalence of obesity-related OA, there is no specific guideline available for obesity-related OA management. In this review, we demonstrated the pathological changes of obesity-related OA and summarized the impact of biomechanical factors by proposing a hypothetical model of obesity-related OA change. Therapeutic strategies based on adjusting abnormal mechanical effects are presented to assist in the management of obesity-related OA.
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Affiliation(s)
- Lianzhi Chen
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | | | - Guangyi Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Yuan
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Jay R. Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - Hengyuan Li
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang, China
| | - John Papadimitriou
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Pathwest Laboratories, Perth, Western Australia, Australia
| | - Qingwen Wang
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - David Wood
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher W. Jones
- Fiona Stanley Hospital Group, Perth, Western Australia, Australia
- Curtin University Medical School, Perth, Western Australia, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
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