Do patients with obesity experience better outcomes after weight loss prior to undergoing treatment for knee injuries?

From the Guidelines

Patients with obesity should lose weight prior to knee injuries to experience better outcomes, as weight loss reduces mechanical stress on knee joints and improves recovery. Weight loss is crucial for patients with a BMI over 25, as it can significantly reduce knee pain and improve function, with a minimum weight loss goal of 5% of body weight 1. A structured weight loss program that combines dietary modification and exercise is recommended, as it can lead to functional improvement measured by the Western Ontario and McMaster Universities (WOMAC) function subscale 1. Key components of such a program include:

• Calorie reduction, typically 500-1000 calories below maintenance needs
• Regular exercise, starting with low-impact activities like swimming or cycling for 150 minutes weekly
• Strengthening muscles around the knee without causing additional pain, particularly for patients with existing knee pain, through working with physical therapists to develop appropriate exercise programs. Weight loss also has broader health benefits, including reducing inflammation throughout the body, which can decrease pain and improve healing processes 1. By prioritizing weight loss, patients with obesity can reduce their risk of knee injuries and improve their overall quality of life, making it a critical recommendation for those with a BMI over 25 1.

From the Research

Weight Loss and Knee Injuries

• Weight loss can have a significant impact on the outcomes of patients with knee injuries, particularly those with obesity 2.
• Studies have shown that intentional weight loss in overweight and obese patients with knee osteoarthritis can lead to improved clinical and mechanistic outcomes, including reduced pain and improved function 2.
• The amount of weight loss can also impact the outcomes, with greater weight loss resulting in superior clinical and mechanistic outcomes 2.

Treatment Options for Obesity

• There are several treatment options available for obesity, including lifestyle interventions, pharmacotherapy, and bariatric surgery 3, 4, 5, 6.
• Pharmacotherapy, such as orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide, can be effective in achieving significant weight loss and improving cardiometabolic risk factors 3, 5, 6.
• Bariatric surgery, such as laparoscopic sleeve gastrectomy, can also be an effective treatment option for obesity, particularly for patients with morbid obesity and severe knee osteoarthritis 4.

Sequence of Interventions

• The sequence of interventions, such as whether to perform bariatric surgery before or after knee surgery, can impact the outcomes of patients with morbid obesity and severe knee osteoarthritis 4.
• Studies have shown that performing bariatric surgery before knee surgery can lead to improved outcomes, including reduced complications and improved knee function 4.
• However, the optimal sequence of interventions may depend on individual patient factors, such as the severity of obesity and knee osteoarthritis, and should be determined on a case-by-case basis 4.