A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
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19 The Medical Student Notebook Bariatric Times • February 2017 was not independently correlated w ith symptomatic relief of knee osteoarthritis in their study. 17 Finally, in a randomized control trial of 24 participants with overweight/obesity with radiographic e vidence of knee osteoarthritis comparing exercise and diet against exercise alone, both exercise and combined exercise and diet interventions improved knee pain, d isability, and performance scores at six months. Furthermore, the combined exercise and diet group demonstrated significantly greater maximum braking force and loading r ates on biomechanical gait testing, indicating that the combination of exercise and diet may have further benefits on improved gait function when compared to exercise alone. 18 T aken together, a recent systematic review and meta-analysis showed that weight loss of over five percent, at a rate of 0.25 percent per week, could result in significant i mprovement in disability due to knee osteoarthritis over a 20-week period. 19 THE EFFECTS OF BARIATRIC WEIGHT LOSS SURGERY ON KNEE OSTEOARTHRITIS While there have been no randomized control trials assessing the effects of weight loss surgery on knee osteoarthritis, multiple studies have shed light on the significant role that bariatric surgery can play. 8,20,21 Roux-en-Y gastric bypass. Several studies have assessed the effects of the Roux-en-Y Gastric Bypass (RYGB) on knee osteoarthritis symptoms. In a 2013 prospective follow-up study assessing the effects of bariatric surgery- induced weight loss on physical function and muscle structure, 16 patients who underwent RYGB showed statistically significant improvements in WOMAC stiffness and function scores, with an average increase of around 10 degrees in knee flexion range motion after 8.8 months. 2 2 A larger 2013 prospective follow- up study of 71 patients with obesity who underwent RYGB assessed the improvement in health-related quality of life factors including diabetes, hypertension, sleep apnea, and knee pain at 3, 6, and 12 months after surgery. At 12 months follow up, the number of patients with reportable knee pain decreased from 43 to 20, a statistically significant amount when analyzed by McNemar's test. 23 Furthermore, a 2007 study assessed the effects of bariatric weight loss surgery on painful musculoskeletal conditions, including neck, shoulder, elbow, lower back, hip, and knee pain and function, in 48 subjects with obesity who underwent RYGB at an academic medical center. Of note, 47 of the subjects in this study were women. Of the 35 patients who initially reported knee p ain, only 21 continued to report knee pain at 6 to 12 month follow up, statistically significant by paired t- test. Furthermore, not only did the number of individuals reporting knee p ain decrease, but the intensity of the knee pain, the knee's physical function, and knee stiffness all showed statistically significant improvement as assessed by the W OMAC index. 2 4 Laparoscopic Adjustable Gastric Banding. In addition to the effects of RYGB on knee osteoarthritis, multiple studies have i nvestigated the effect of laparoscopic adjustable gastric banding (LAGB) on the symptoms of knee osteoarthritis as well. A 2007 study assessing the effect of LAGB on o besity-associated diseases, including diabetes, pulmonary disease, knee pain, and others in 145 patients with morbid obesity who underwent LAGB showed a decrease in the prevalence o f knee pain from 47 percent to 38 percent over a 3 to 8 year follow-up period. 25 Not only has research demonstrated subjective i mprovements in knee pain and function from LAGB, but radiographic improvements have been shown as well. In a study of 64 patients undergoing LAGB with knee o steoarthritis, radiographic data showed an increase in medial joint space from 4.6mm to 5.25mm three months post-surgery. In addition, knee pain and function showed s ignificant clinical improvement as measured by the American Knee Society Score index over the three- month period. 9