Reduction of invasive interventions in severely obese with osteoarthritis after bariatric surgery

Osteoarthritis (OA) affects 56,000,000 Americans, 30% with obesity. Their risk of developing OA is 5 times higher. With each extra kilogram above ideal weight, the risk of OA increases to 13%. The study aim is to describe changes in OA treatment after undergoing bariatric surgery (BS).

After IRB approval, we conducted a retrospective analysis of all severely obese patients and OA that underwent laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass from 2004 to 2018. Changes of OA severity were assessed based on the requirement of invasive intervention (INI) at 12 and 24 months after BS. INI was defined as the need for surgical drainage; articular injection; and surgical interventions such as meniscectomy, total hip replacement, and total knee replacement.

A total of 11.52% (N = 486) had OA diagnosed prior to BS, the most common location being unilateral hip 31.1% (N = 151). A total of 35.2% (N = 159) of patients required pain management (PM) for OA at 12 months. Of these, 90% (N = 144) required only INI and 5.6% (N = 9) required PM only. Baseline and postoperative BMI were associated to need for INI. At 12 months, the 66.7% (N = 301) who did not require INI had a baseline BMI of 44.70 ± 8.22 and total weight loss percent (TWL%) of 14.29 ± 13 (P = 0.05; 95% CI 0.96-1.00). LSG patients were the majority compared to other procedures (44.5%; N = 134). On the other hand, 64.3% (N = 175) did not require INI at 24 months and had a baseline BMI of 17.82±17.4 and TWL% of 2.43 ± 6 (P = 0.003; 95% CI 1.04-1.25). The risk to require INI was reduced by 69.9% at 12 months and 80% at 24 months. Need for pain medications at 12 months was reduced by 96.9%.

According to this study data, bariatric surgery reduces the need for INI in patients with OA. The effect seems to be related to the amount of weight loss. Additional studies conducted on a larger scale are necessary to validate findings.