Bariatric Surgery Can Improve the Lives of Obese Patients With Knee and Hip Arthritis
If you are overweight and suffer from osteoarthritis, new research found that bariatric surgery relieved pain and improved quality of life for a large group of patients.
Quality of life can be significantly improved after bariatric surgery, according to Walter J. Pories, MD, Professor of Surgery, Biochemistry, and Kinesiology at the Brody School fo Medicine at East Carolina University in Greenville, North Carolina.
Many patients are referred for bariatric surgery by orthopedic surgeons, he noted. “Their doctors tell them they need to lose a large amount of weight before they can have joint replacement surgery,” he explained.
Dr. Pories was co-investigator on a study recently published in the Journal of the American Medical Association, which found that in the three years following bariatric surgery, the majority of patients experienced an improvement in pain and walking ability, and reported having less back or leg pain intere with work.
The study found that in patients who had bariatric surgery, walking became easier, which improved their ability to adopt a more physically active lifestyle. The average physical function score, which is based on a person’s ability to walk various distances, climb stairs, perform vigorous and moderate activities, lift and carry groceries, bathe, dress, bend and kneel, improved to the point that it was comparable to that of the general population.
Some patients did continue to have significant pain and disability, however. “Before surgery, at least one-third of patients have some arthritic complaints,” Dr. Pories said. “Following surgery, almost everyone improves, many quite sharply, but almost no one is totally pain-free.”
The study followed 2,221 patients for three years after surgery. About three-fourths of patients with osteoarthritis symptoms before surgery had improvements in knee and hip pain and function. More than half of participants who had problems moving before surgery did not have mobility problems afterwards.
The risks of bariatric surgery are relatively low, Dr. Pories said. “The American Society for Metabolic and Bariatric Surgery has analyzed 450,000 patient records, and found the 90-day mortality for bariatric surgery is 0.3%, or 3 per 1,000 patients,” he said. “To put that into perspective, that’s about the same as a routine gallbladder operation, and lower than coronary artery bypass, which is 2-4%.”
He notes that patients who undergo bariatric surgery may be at increased risk for complications because they often have other physical illnesses such as type 2 diabetes, as well as mental illnesses. These factors also could play a role in patients’ perception of pain.
Another positive result from the surgery is that most patients are able to cut down on pain medication for their arthritis following the procedure, according to Dr. Pories.
Bariatric surgery patients, especially women, may be at slightly increased risk of developing osteoporosis. In some patients, this may be due to malnutrition, Dr. Pories said. “The operation, which shrinks the stomach, is designed to interfere with nutrition,” he explained. “That is why we are very careful to urge patients to take double dose of over-the-counter multivitamins daily. But at least 10% of patients stop taking them within a year, which could be a contributing factor to osteoporosis.”
Malnutrition may also contribute to bariatric surgery patients’ nerve pain, numbness or tingling, due to a lack of micronutrients known as trace elements (such as copper, zinc or manganese). “Taking a double dose of multivitamins tends to sharply improve this problem,” Dr. Pories said.
While the surgery does have risks and some health effects, it is important to realize how much of a difference the operation can make in many patients’ lives, he observed. “We get patients who are wheelchair-ridden or unable to walk at all. It’s almost a miracle to see these same patients come back to the office, first with a walker, then with a cane and, finally, walking without any aids.”
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