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A
71 year old obese female with history of knee pain
presents to the office for evaluation and treatment.
Patient states she has no pain as long as she is
sitting, going downstairs hurts her much more than going
up. Knees are always swelled up.
Knees get real stiff after sitting for about 30 minutes.
She has to use a pillow between her knees when she
sleeps. She can not walk more than a few steps before
stopping.
Her past medical history is negative for Rheumatoid or
any other connective tissue diseases. Tylenol helps some
times. She says "I have tried everything including
acupuncture , synvisc injections, cortisone injections
and anti-inflammatory medication with no improvement."
Patient is 5 feet tall and weights over 280 pounds. She
has been advised for
total knee replacement.
Discussion:
The prevalence of both obesity and knee arthritis
continue to increase globally more so in the developed
countries. In the United States alone almost 33% of the
adult population are considered as obese, while knee
pain is the number one reason for visits to the center.
Weight loss can decrease knee pain if patient is greatly
overweight. However weight loss alone is unlikely to
completely relieve the pain. Obesity also makes other
complications such as Diabetes, heart disease, cancer...
Studies have shown that obese persons, especially obese
older women, are at higher risk for knee osteoarthritis
(OA). We have learned from The Framingham Study (The
largest study done up to this point which is a landmark
study, it began in 1948 in which some 12,000 residents
of the town of Framingham, Massachusetts were enrolled)
that a drop in weight as little as 11 lbs can decrease
the risk of developing knee osteoarthritis. On the basis
of epidemiologic findings such as these, the center
likes to start a weight loss program as early as
possible on the patients who suffer from osteoarthritis
of knee, hip or ankle (the weight bearing joints).
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