The impact of sarcopenic obesity on knee and hip osteoarthritis: a scoping review

Abstract

BackgroundThe progressive, debilitating nature of knee and hip osteoarthritis can result in severe, persistent pain and disability, potentially leading to a need for total joint arthroplasty (TJA) in end-stage osteoarthritis. TJA in adults with obesity is associated with increased surgical risk and prolonged recovery, yet classifying obesity only using body mass index (BMI) precludes distinction of obesity phenotypes and their impact on surgical risk and recovery. The sarcopenic obesity phenotype, characterized by high adiposity and low skeletal muscle mass, is associated with higher infection rates, poorer function, and slower recovery after surgery in other clinical populations, but not thoroughly investigated in osteoarthritis. The rising prevalence and impact of this phenotype demands further attention in osteoarthritis treatment models of care, particularly as osteoarthritis-related pain, disability, and current treatment practices may inadvertently be influencing its development.MethodsA scoping review was used to examine the extent of evidence of sarcopenic obesity in adults with hip or knee osteoarthritis. Medline, CINAHL, Web of Science and EMBASE were systematically searched from inception to December 2017 with keywords and subject headings related to obesity, sarcopenia and osteoarthritis.ResultsEleven studies met inclusion criteria, with indications that muscle weakness, low skeletal muscle mass or sarcopenia are present alongside obesity in this population, potentially impacting therapeutic outcomes, and TJA surgical risk and recovery.ConclusionsConsideration of sarcopenic obesity should be included in osteoarthritis patient assessments.

End-stage knee osteoarthritis with and without sarcopenia – and the effect of knee arthroplasty

“…One important difference between the current study and the previous researches on sarcopenia with surgery is that those surgeries mainly induce a catabolic status in the patients while knee arthroplasty induces catabolism in early phase followed by anabolism due to patient regaining their mobility and ability to exercise. This phenomenon could also be a possible explanation of the signi cant improvement of lean mass in overweight or obese sarcopenic female in our study as they lost fat and weight during the initial catabolism after arthroplasty and built up muscle, made possible by better walking ability and less bodyweight hindering movement, during their subsequent rehabilitation [20,35,43]. In essence, knee arthroplasty helps break the vicious cycle of immobility, obesity and sarcopenia by returning these individuals to normal lower limb function.…”

“…The total reduction in energy expenditure, together with ageing-related gains in adipose tissue lead to many patients developed overweight or even obesity. The excess load will further exacerbate their knee OA progression, and it is the combination of these factors that been regarded to create and perpetuate a vicious cycle between obesity, sarcopenia and osteoarthritis [20,21].…”

End-stage knee osteoarthritis with and without sarcopenia and the effect of knee arthroplasty – a prospective cohort study

“…One important difference between the current study and the previous researches on sarcopenia with surgery is that those surgeries mainly induce a catabolic status in the patients while knee arthroplasty induces catabolism in early phase followed by anabolism due to patient regaining their mobility and ability to exercise. This phenomenon may potentially explain the improvement of lean mass in overweight or obese sarcopenic female in our study as they lost fat and weight during the initial catabolism after arthroplasty and built up muscle, made possible by better walking ability and less bodyweight hindering movement, during their subsequent rehabilitation [19,38,44]. However, the nding is limited by the small scale of our study and further studies with larger sample sizes are warranted to validate this relationship.…”

“…In turn the subsequent reduction in energy expenditure, together with ageing-related gains in adipose tissue lead to these patients developed overweight or even obesity. This increased load would further exacerbate their knee OA progression, and it is the combination of these factors that have been regarded to create and perpetuate a vicious cycle between obesity, sarcopenia and osteoarthritis [19,20].…”

Risk for hip fracture before and after total knee replacement in Sweden

“…A higher BMI in women and men with knee osteoarthritis could therefore be an explanation for the lower risk for hip fracture we found in the period before TKR. However, obesity is an inflammatory condition with an increased risk for type 2 diabetes and cardiovascular disease, and low muscle mass and low physical performance are associated with obesity [27,29]. These are all risk factors for hip fracture, and abdominal obesity have been associated with an increased risk for hip fracture [28,[30][31][32][33].…”