Watch your weight to avoid arthritis

Being only 1 kg overweight increases the force on the knee by 4-6 kg with each step With 120 kilos of body weight patient opted Total Knee Replacement (TKR) Surgery successfully 15th June, 2015, Hyderabad: “Obese patients are at high risk of arthritis as every extra kilo increases the force on knees by 4-5 times.

Obese patients suffering from arthritis find it difficult to exercise or walk to shed the extra kilos. In some cases, knees deteriorate to the extent that it starts affecting their movement and performing even the basic activities becomes challenging. Such patients, in Stage IV arthritis are usually candidates for Total Knee Replacement (TKR) Surgery. However, they are often considered unfit for TKR due to fear of complications and are recommended for weight loss first.

Due to severe pain and mobility issues, losing weight at this stage is unrealistic. We at Landmark Hospitals have successfully operated upon many such high risk patients under special medical cover. The results in these patients are extremely good and the patient satisfaction is very high.”Written by Dr. Sudhir Reddy Sr. Consultant, Joint Replacement, Landmark Hospital Be it academic, work or social setting, there exists a strong prejudice in our country against obese persons.

Medically, obese people are at a higher risk of conditions such as Diabetes, cardiac disorders and psychiatric Dealing with 120 kilos of body weight was never easy for my patient Afzal Kahan from Hyderabad. However, over 65 years of lifespan, life had taught him to face day to day challenges sportingly. Even cardiac disease he suffered could not deter him. But seemed like life was up for another challenge when two years ago, Afzal was diagnosed of arthritis. What began as mild pain and stiffness, gradually progressed as Grade IV arthritis.

The pain was so severe that it started impacting his mobility on day to day basis. “It seemed like the most difficult time of my life. I had never felt to so deprived….so helpless. I was in severe pain and couldn’t move around independently. Had to shut down my business and was completely home bound, wheelchair bound and dependent on my family even for basic routine activities.” recollects Afzal. In such cases, Total Knee Replacement (TKR) is usually the most suitable option for pain relief and regain mobility.

However, Afzal’s situation appeared grim, when he was refused TKR due to excessive weight by most joint replacement surgeons he consulted. Excessive weight had left Afzal’s knees severely stressed over the years. It caused irreversible damage to both his knees making him almost immobile.

But this isn’t the story of Afzal alone. Obesity, a major healthcare problem in developed nations has made inroads in India over past few decades. Poor eating habits, increasing preference for junk food especially amongst kids and young, lack of hard work and physical activity are some of the factors causing increasing number of Indians having high Body Mass Index (BMI). Knees are the highest weight bearing joints in our body. Any extra weight places extra pressure on knee joint, stresses muscles, causes early wear of smooth and soft articular cartilage, eventually resulting in arthritis.

Every 1 kg extra weight gain can exert 4-5 times additional pressure on knees at every step. This constant pressure speeds up the wear and tear of knee joint, causing its degeneration. Weight reduction is very useful for patients suffering with obesity, as it improves the symptoms and progression of arthritis. Physiotherapy and some changes in daily activities like prolonged standing, excessive stair climbing, avoiding cross leg sitting and Indian toilets may help significantly in early stages of arthritis.

Certain nutritional supplements may help cartilage nutrition and alter the progress of arthritis. Non-steroidal anti-inflammatory drugs are commonly used to treat the pain arising from arthritis. But their consistent use is harmful especially to the stomach and kidneys. Hence, long-term and unsupervised use must be avoided.

TKR may be best solution when patient suffers from pain so intense that it interferes with routine activities and mobility and when alternate therapies have failed to provide relief. Usually this happens in Grade IV arthritis. However, obese patients suffering from severe knee arthritis and recommended for Knee Replacement face a peculiar problem.

Those with BMI of more than 40 are usually considered unfit for surgery due to fear of complications are recommended weight loss before surgery. There is also misguided belief that Knee replacement surgery is not very successful in obese patients.

Since most of these patients are in severe pain and face mobility issues, weight reduction at this stage is unlikely. It is a common belief that high body weight may lead to a less- than-optimal outcome of TKR due to increased stress across the components and increased load on surrounding bone.

However evidence suggests that Total Knee Replacement surgery is as successful in obese patients as in non- obese patients and satisfaction rates are extremely high (Over 95%). In my experience, at Landmark Hospital I have successfully operated upon many such patients with BMI to the excess of 40. However, such patients do require special medical cover during the procedure. Post knee replacement these patients become free of pain and many of them loose at least 10 kgs during first year, through better mobility.

In TKR, the damaged joint surface is removed and replaced with artificial joint. These prostheses are made up of a combination of metal and sturdy plastic. The materials used in a Joint Replacement Surgery are designed to enable the joint to withstand the body loads and move just like a normal joint. Many patients like Afzal have got a new lease of life with Total Knee Replacement surgery. New age knee Implants such as Single Radius knee have improved the surgical outcome and implant longevity. These implants are made of stronger, more durable material and last for decades. Post TKR patients can do almost all activities of daily living, but most importantly are relieved of pain.

Afzal’s situation was very grim before the surgery. But when he started walking independently on 3rd day of the surgery, it seemed that TKR was indeed the best decision he ever took. Today, he is leading a normal life and running his day to day business independently. Not only did his physical health improved but life change for good socially and psychologically.