Osteoarthritis and obesity; conservative management, multi-morbidity, surgery and the implications of restricted access to knee or hip replacement: a literature review

• Published in: International journal of orthopaedic and trauma nursing 2021-02, Vol.40, p.100840, Article 100840
• Main Author: Midgley, James
• Format: Article
• Language: English
• Subjects: Arthroplasty; Body mass index; Exercise; Obesity; Osteoarthritis; Replacement; Weight loss
• ISSN: 1878-1241
• DOI: 10.1016/j.ijotn.2020.100840

Osteoarthritis is a significant health issue for many over the age of 65. Obesity is an accepted risk factor for the development of OA. Weight loss and exercise are fundamental evidence based conservative management strategies. Obese patients with OA are, however, at increased risk of requiring surgical intervention. BMI as a measure of obesity, is being used by many commissioners in the UK as an eligibility criterion for surgery. Many patients with end stage arthritis now find themselves unable to have joint replacement surgery because of their weight. This evidence informed review provides focus on those with obesity and OA, considering management strategies in this group. The additional impact of multi-morbidity on this cohort is considered. The available literature concerning those requiring surgery but who are denied joint replacement surgery because of their weight is explored. A non-systematic literature review was undertaken to facilitate analysis of this subject. The manuscript uses the SANRA criteria as a framework of quality assurance. Osteoarthritis and associated obesity is a significant public health issue. Patients need greater support in maximising their conservative management options, including the promotion and facilitation of weight loss and exercise, possibly combined; a multi-professional responsibility for all healthcare workers, including those in the nursing profession. A greater research emphasis should be placed on investigating and developing enhanced care frameworks for this large cohort of patients, especially supporting those who are denied surgery because of their weight. •This review considers the impact of obesity on OA and the role of weight loss and exercise as core treatment strategies.•The review highlights that there are a growing number of patients with hip and knee end stage OA who require joint replacement surgery but who are denied surgery because of their weight.•Evidence is cited that suggests the majority of {morbidly} obese patients denied surgery because of their weight, fail to lose weight.•This review highlights that this growing cohort of struggling patients are currently under supported by existing care frameworks and concludes that more research into this subject should be prioritised.