Friday Favorites: The Best Knee Replacement Alternative for Osteoarthritis Treatment

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The largest study in history on the health effects of being overweight, analyzing data from more than 50 million people from nearly 200 countries, found that excess body weight accounts for the premature deaths of about 4 million people every year. Most of these deaths are from heart disease, but the researchers found “convincing” or “probable” evidence linking obesity to twenty different disorders—a veritable alphabet soup of potential health concerns.

In the ABCs of health consequences, A is for arthritis. Obesity can make rheumatoid arthritis worse, and increase the risk of another inflammatory joint disease, the so-called “disease of kings,” gout. The most common joint disease in the world, though, is osteoarthritis, and obesity may be the main modifiable risk factor.

Osteoarthritis develops when the cushioning-cartilage-lining of joints breaks down faster than your body can build it back up. The knees are the most commonly affected, leading to the assumption that the relation to obesity was simply the excess wear and tear from the added load on the joints. But, non-weight-bearing joints like the hands and wrists can also be affected, suggesting the link isn’t purely mechanical. Obesity-related dyslipidemia may be playing a role, with elevations in the amounts of triglycerides, fat, and cholesterol in the blood aggravating inflammation in the joints, just like cholesterol can aggravate the inflammation in your artery walls.

Osteoarthritis sufferers not only have higher cholesterol levels in the blood; they have higher cholesterol levels within their joints, both in aspirated joint fluid and in the cartilage itself. Drip cholesterol on human cartilage in a petri dish, and you can worsen the inflammatory degeneration, helping to explain why the higher people’s cholesterol, the worse their disease. Cholesterol-lowering statin drugs may both help prevent and treat osteoarthritis, as can a cholesterol-lowering diet. A healthy enough plant-based diet may offer the best of both worlds, dropping cholesterol as much as a starting dose of a statin drug—within a single week—and only has good side effects, such as lowering blood pressure and facilitating weight loss.

Even just losing about a pound a year over the span of a decade may decrease the odds of developing osteoarthritis by more than 50 percent. Weight reduction may even obviate the need for knee-replacement surgery. Obese osteoarthritis sufferers randomized to lose weight improved their knee function as much as those going through surgery––within just eight weeks. The researchers concluded that losing 20 pounds of fat “might be regarded as an alternative to knee replacement.”

Isn’t it easier to just get your knees replaced than lose 20 pounds? Rarely discussed is the fact that nearly 1 in 200 knee replacement patients die within 90 days of surgery. Given the extreme popularity of this operation—about 700,000 a year in the U.S.—an orthopedics journal editor suggested that “people considering this operation are inadequately attuned to the possibility that it may kill them”––arguably, the “single most salient fact” to share with a patient considering the operation. An orthopedic surgeon responded to questioning whether patients should be told about the chance the operation may kill them: “To me, the real question is whether this knowledge will help the patient. Will it add to the anxiety of the already-anxious patient, perhaps to the point of denying that patient a helpful operation? Or will this knowledge motivate a less-handicapped patient to stick to a diet and physical activity regime? Ultimately, then, the question boils down to the surgeon’s judgment.”

Even among the vast majority who survive the surgery, approximately one in five knee replacement patients describe being unsatisfied with the outcome. Weight loss with a healthy diet, on the other hand, may offer a nonsurgical alternative that instead treats the cause, and offers only beneficial side effects.

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Motion graphics by Avocado Video