Obesity should not be barrier to knee surgery

Cases of ‘rationing’ by NHS trusts of heath services such as elective operations for obese people has been criticised by the National Obesity Forum. This paper, published online in Annals of Rheumatic Disease, suggests such decisions are unfounded.

A team from the Epidemiology Resource Centre at Southampton General Hospital and colleagues followed up 325 patients from three areas in England six years after they had had total knee arthroplasty. They compared these with 363 controls in the general population.

Information on age, sex, other diseases, body mass index, functional status and severity of osteoarthritis was collected as baseline. Subjects were questioned on functioning six years later by postal questionnaire and change in physical function was calculated.

Those that had undergone knee operations had a six point improvement in physical function but in controls there was a fall of 14 points.

The improvement was smaller in patients who were obese than in patients that weren’t but was much better than obese controls who experienced a substantial decline in the physical function over the six years.

Cyrus Cooper, lead author and professor of bone medicine at the Institute of Musculoskeletal Sciences in Oxford said: ‘There seems no justification for withholding total knee arthroplasty from obese patients solely on the grounds of their body mass index.’

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