Background/Purpose: Obesity is a modifiable risk factor for knee osteoarthritis (OA), yet diet and exercise often fail to achieve sustained weight loss or knee improvement. Recent studies suggest that bariatric weight loss surgery has a significant impact on both obesity and knee pain in this population. We aimed to quantify knee pain improvement in obese patients opting for the laparoscopic adjustable gastric band (LAGB), and further support its use in refractory knee OA.

Methods: We identified bariatric surgery patients from the New York University Langone Weight Management Program Research Registry (2002-2015) who were ³18 years old at the time of surgery, reported knee pain pre-operatively, and had no previous history of rheumatoid arthritis, psoriatic arthritis, or lupus. Participants rated their knee pain on a scale from 0 (best) to 10 (worst) at three time points: (1) before bariatric surgery, (2) one year after surgery, and (3) at the time of survey administration. They reported any family history of OA, knee injury or surgery before onset of knee pain, and presence of OA in other joints. We obtained patient height and weight from their charts at the first two time points, and used self-reported weight for the third time point. ANOVA was used to analyze the relationship between change in knee pain rating and various perioperative and postoperative patient characteristics, including baseline age and body mass index (BMI).

Results: Of the 617 bariatric patients eligible for the study, 120 LAGB patients were included. By one year post-LAGB, the BMI decreased by a mean of 11.2 kg/m², and knee pain decreased from 6.88 to 3.34. We found a significant difference in knee pain improvement by age group at one year post-LAGB (p=0.009). Those who had a knee injury prior to onset of knee pain showed less improvement at one year post- LAGB than did those who were injury-free (p=0.04), though a history of knee surgery was not similarly significant. Patients with OA in other joints had less improvement by a margin of 2.75 vs 4.22 (p=0.001). There was no significant relationship between baseline BMI and knee pain improvement at one year post-LAGB, but the subgroup with the highest BMI improvement had the most knee improvement (p=0.043). Though knee pain improvement trended with decreased BMI at one year post-LAGB, the difference between BMI groups was no longer significant at the time of survey administration (mean 9.14 years, median 10 years).

Conclusion: LAGB weight loss surgery results in a significant reduction of knee OA pain, especially in younger patients and those without prior knee injury or other involved joints. This further supports LAGB as a viable treatment option in the algorithm for refractory knee OA pain in obese patients, irrespective of a patientÕs degree of obesity.

Table 1. Various perioperative and postoperative factors affecting knee OA pain rating improvement in a cohort of 120 laparoscopic gastric banding patients (2002-2015)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-characteristics-that-predict-the-effect-of-laparoscopic-adjustable-gastric-band-weight-loss-surgery-on-knee-osteoarthritis-pain/