New Study Homes in on Joint Improvements Post Bariatric Surgery

Marlene Busko

November 10, 2015

LOS ANGELES — More than half of obese patients with debilitating joint pain and difficulties with physical activity no longer had impaired mobility 3 years after bariatric surgery, according to new data from the Longitudinal Assessment of Bariatric Surgery 2 (LABS-2) study.

Patients who were younger, male, had a higher household income, lower body mass index (BMI), and/or fewer depressive symptoms before surgery were more likely to have less joint pain and better physical functioning after bariatric surgery, Wendy King, PhD, associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health, Pennsylvania, reported here at Obesity Week 2015.

It may seem obvious that obese patients who lose weight after bariatric surgery would have less joint pain and find it easier to walk, but this study provides greater insight into which specific patients will be more likely to have these benefits and a clearer picture of longer-term outcomes, Dr King told Medscape Medical News.

It was "particularly exciting" that of the 38% of patients with severe knee or hip pain before surgery, 70% had less pain in these joints and a clinically meaningful improvement in physical function following weight-loss surgery, she added.

Asked to comment, session cochair Michel Gagner, MD, a bariatric surgeon from Hôpital du Sacre Coeur, Montreal, Quebec and a member of the original LABS group, noted that bariatric surgeons often see obese patients who plan to have hip- or knee-replacement surgery to relieve pain but need to lose weight to qualify for surgery. After they have the weight-loss procedure, some patients may no longer have severe joint pain that warrants joint-replacement surgery.

"I think if [obese patients who undergo bariatric surgery] have less joint pain, we will see less hip replacement, knee replacement, arthroscopic surgery done on ankles, and surgery done on feet," which would also be cost saving because prostheses may need to be replaced after one or two decades, he noted.

This study will help clinicians better identify the patients who are likely to reap the most mobility benefits after bariatric surgery, as well those who may still need pain management to be able to have an active lifestyle, said Dr King.

Investigating Remission in Common Joint Pain

Severely obese patients who have bariatric surgery commonly have debilitating joint pain that makes it hard for them to lift things, bend over, or walk, explained Dr King. Previous research has reported dramatic improvements in short-term mobility after bariatric surgery, but these have generally been small, short studies using outdated types of bariatric procedures.

The researchers aimed to identify factors associated with clinically meaningful improvements in joint pain and physical function during 3 years of follow-up of patients in the LABS-2 study.

They analyzed data from 2221 patients who had bariatric surgery, mostly Roux-en-Y gastric bypass (70%), but also laparoscopic adjustable gastric band (25%) and other procedures (5%).

Most patients were women (79%) and 87% were white. They had a median age of 47 years and a median BMI of 46 kg/m2.

At baseline, patients who were unable to walk 400 m in 7 minutes or less (fast enough to cross an intersection) were deemed to have impaired mobility, and about half of patients (1033) met this criteria.

Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and Short-Form Health Survey (SF-36), which assessed pain, related medication use, walking capacity, and potential confounders before surgery and each year after surgery. Close to one in five (353) patients reported using narcotics to manage joint pain before surgery.

Three years after bariatric surgery, 54% of patients who had had mobility problems were no longer impaired. And about half of patients (46%) who had used prescription narcotics to control joint pain before surgery no longer used these drugs afterward.

Having a history of stroke, cardiovascular disease, diabetes, and venous edema with ulceration after bariatric surgery predicted worse mobility outcomes.

"The majority of patients do experience clinically important improvements in pain and function," said Dr King.

However, there's an important subpopulation that doesn't, so they may need further intervention to be able to improve their quality of life and meet behavioral goals such as increasing their level of physical activity.

The research was funded by the US National Institutes of Health.

Obesity Week 2015; Los Angeles, California. Abstract A109, presented November 4, 2015.

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