Jump to comment:
- Page navigation anchor for RE: Is it weight loss or exercise that matters in osteoarthritis?RE: Is it weight loss or exercise that matters in osteoarthritis?
In the recent review article on management of osteoarthritis, Khan et al. recommend weight loss as one of the non-invasive treatment modalities.1 The text and refences however, primarily discuss the effectiveness of exercise. Although there is an association between obesity and osteoarthritis of the knee, it is difficult to find convincing evidence that weight loss itself leads to improved pain or function. The referenced study by Messier, for example, showed that whereas the diet plus exercise group showed improvement in pain and several indicators of physical function the diet only group showed no improvement in any outcome compared to control although both groups demonstrated a similar and significant amount of weight loss (4.6kg and 5.2 kg respectively). Other studies including a more recent study by the same author2 produced similar results despite even greater weight loss for both groups suggesting that it is exercise, not weight loss that leads to improvement in pain and function. Khan et al also refer to the documented increased in biomechanical load on the knee in obesity, reinforcing our conventional, intuitive assumption that greater force equals greater pain and therefore less weight / less force will result in less pain. What is missing is clinical trial evidence that this is the case.
The distinction between advising weight loss and advising exercise is significant. Not only is weight loss generally ineffective, as the vast majority of patients w...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: High tibial osteotomy technique for knee osteoarthritisRE: High tibial osteotomy technique for knee osteoarthritis
The tibial osteotomy procedure can, in select cases, be an effective treatment option for younger patients with respect to pain relief and improvement in function. The findings of the Cochrane review by Brouwer et al concluded “valgus high tibial osteotomy reduces pain and improves knee function in patients with medial compartmental osteoarthritis of the knee”.
To be clear our comments with respect to HTO were in comparison to other surgical procedures and not with regards to non-operative treatment. In fact, none of the included studies in the Cochrane review directly compared osteotomy to conservative treatment.
For this reason, the authors of the Cochrane review clarified “No evidence shows whether an osteotomy is more effective than alternative surgical treatment such as unicompartmental knee replacement or non-operative treatment” meaning no study is available in the literature to inform the direct comparison between high tibial osteotomy and conservative treatment. Additionally, it is important to note as we indicated all available comparative studies are of low quality evidence and further study is needed to clarify the role of specific techniques and procedures.
Competing Interests: None declared. - Page navigation anchor for High tibial osteotomy technique for knee osteoarthritisHigh tibial osteotomy technique for knee osteoarthritis
The authors cite a Cochrane Review from 2014 to support the position that tibial osteotomy "improved pain and function, although available evidence was of limited quality....(in disabling osteoarthritis)." Seems they were wearing rose-coloured orthopaedic glasses when they read this exhaustive review.
In fact Brouwer et al. (2014) conclude "No evidence shows whether an osteotomy is more effective than..... non-operative treatment. So far, the results of this updated review do not justify a conclusion on benefit of specific high tibial osteotomy technique for knee osteoarthritis."
Competing Interests: None declared.