Osteoarthritis and Obesity
Chris C-T Chen, PhD
Shevaun Doyle, MD
Daniel Green, MD
Howard Hillstrom, PhD
Hollis Potter, MD
Peter A. Torzilli, PhD
Hospital for Special Surgery
New York City, NY
LSTR
40
1999-2000
2001-2002
2003-2004
2003-2006
% Obese
30
Ogden et al. JAMA 2006, 2008
20
10
0
2-5
6-11
12-19
Age
20-39 40-59
>60
Population Affected by Arthritis in USA
Helmick et al., A&R, 2008
60
% of Population
17.2 million
50
40
Self-assessed
All types
20.5
30
27.2
34.6
46.2
18.7
20
4.4
1.9
8.7
10
0
5.1
Total
Men Women 18-44
45-64
65+
White Black Hispanic Other
Activity Limitation from Arthritis in USA
Helmick et al., A&R, 2008
% Limited/Affected
30
25
3.9 million
20
15
2.4
2.8
10
3.3
4.1
0.5
1.3
0.3
5
0
0.1
0.3
Total
Men Women 18-44
45-64
65+
White Black Hispanic Other
Types of Arthritis in USA
Helmick et al., A&R, 2008
100
% of Population
43.2 million
~21 million
Clinical OA
Self-assessed
10
1
1.3
1.3
0.3
0.1
0.1
0.01
OA
RA
JRA
SLE
Other
What affect does obesity have on osteoarthritis?
Obesity and osteoarthritis in knee, hip and/or hand
Grotle et al. BMC Musculoskelet Disord (2008)
In a 1994 Norwegian study of 1854 people aged 24-76 yrs
At 10-years follow-up high BMI (> 30) was associated with
• Knee OA
(OR 2.81; 95%CI 1.32-5.96)
• Hand OA
(OR 2.59; 1.08-6.19)
• But not Hip OA
(OR 1.11; 0.41-2.97)
Lifetime risk of symptomatic knee osteoarthritis
Murphy et al. , A&R (2008)
• 3,068 participants, Johnston County Osteoarthritis Project
• Black and white women and men age 45+ years rural NC
• Radiographic, sociodemographic, and symptomatic knee
• Baseline (1990-1997) and first followup (1999-2003)
•Symptomatic knee OA risk was 44.7%
•Knee injury had a lifetime risk of 56.8%
•Risk increased with increasing BMI
•Risk of 66% among those who were obese
Knee Osteoarthritis, Body Weight and Joint Alignment
Felson et al., Arthritis & Rheumatism (2004)
Patient Population
Knees OA Progression 90/394
Age
66.4±9.4 yrs
Women
41.0%
BMI
30.6±4.7 kg/m2
Median Alignment
2.1o varus
Varus/Neutral/Valgus
67%/7%/26%
Progression of knee OA via Joint Space Narrowing on Radiographs
BMI, Alignment and Knee OA Progression
40
Felson et al., A&R, 2004
9.2%
22.3%
48.7%
BMI, kg/m2
30
Percent of malaligned knees with OA
progression
For each 2-unit increase in BMI, there
was an 8% increase in the risk of
progression (odds ratio=1.08, p=0.03)
20
10
0
0-2 deg
3-6 deg
>6 deg
Childhood Orthopedic Diseases Linked to Obesity
• Genuvalgum
• Slipped Capital
Femoral Epiphysis
(SCFE)
• Blount’s Disease
(tibia vara)
Blount’s Disease
Orthopedic Complications of Overweight
in Children and Adolescents
Taylor, E.D. et al. (2006) Pediatrics
Children (93; <12 yrs) and Adolescents (242; 12-18 yrs)
• 227 overweight (BMI>95th percentile) age 12.6±2.7
• 128 non-overweight (5th-95th percentile) age 11.8±2.9
Most common joint compliant was knee pain
6.6% overweight vs. 2.3% non-overweight
In adolescents (12-18 yrs) 18.3% overweight vs. 4.8% non-overweight
Taylor, E.D. et al. (2006). Orthopedic complications of overweight in children and adolescents. Pediatrics. 117 (6): 2167-2174
Tibial Growth Plate and Lower Extremity Alignment
• 159 overweight vs. 91 non-overweight
• Tibial growth plate – tibial axial alignment
• Femoral - tibial axial alignment
Tibial-Growth Plate Alignment
Valgus alignment
Overweight > non-overweight
Femoral-Tibial Alignment
Not different
Tibial-Growth
Plate Alignment
Fem-Tib
Alignment
Taylor, E.D. et al. (2006). Orthopedic complications of overweight in children and adolescents. Pediatrics. 117 (6): 2167-2174
Obesity and Lower Extremity Malalignment
“A major unanswered question in
the study of growth plate
cellular function is the extent to
which chondrocytic activity is
also modulated by the
biomechanical environment of
the growth plate”
Cornelia E. Farnum
(Cells Tissues Organs 2000)
Genu valgum
Surgical Options for Correcting Malalignment
Stapling is a successful way to surgically
correct valgus and varus deformities caused
by unequal growth rates across a given physis.
Treatment of Genuvalgum
Obesity, OA and Children
• Only 19 papers found from 1999-2008
Effects of childhood obesity on three-dimensional
knee joint biomechanics during walking
Gushue, Houck and Lerner, A. L., J Pediatr Orthop (2005)
• During early stance overweight children had
• Lower peak knee flexion angle
• Higher peak internal knee abduction moment
• Overweight children may develop a gait adaptation
leading to increased joint loads and high contact stress
• Childhood obesity may impart a greater risk for the
development of osteoarthritis due to repetitive high stress
Multiscale Modeling
Changes in joint mechanics
may predispose the joint
to develop osteoarthritis
Higher Stress
Shift in Location
Changes in joint mechanics
may alter the normal
metabolic balance
Andriacchi (2004) Annals of Biomedical Engineering
Lower Extremity Alignment, Gait,
and Joint Pathophysiology in
Overweight and Normal Weight Children
Co-PIs:
Howard Hillstrom, PhD
Christopher Chen, PhD
Alejandro Diaz, MD
Mary J. Ward, PhD
Maura D. Frank, MD
Daniel Green, MD
HSS
HSS
Weill-Cornell
Weill-Cornell
Weill-Cornell
HSS
Co-PIs:
Peter Torzilli, PhD
Mary Goldring, PhD
Sherry Backus, PT, DPT
Sarah Shultz, PhD
HSS
HSS
HSS
Temple
Study the role of joint malalignment and BMI in overweight and
normal weight children in the development of osteoarthritis
 Motion analysis of gait and joint mechanics
 Systemetic biomarkers for OA and bone pathophysiology
Obesity, OA and Children Wish List
Biomechanical
Joint alignment
Joint kinematics (motion)
Joint dynamics (contact stresses
Imaging (hard and soft tissues)
Radiographs
MR Imaging
Biological (hard and soft tissues)
Genetic
Systemic
Biomarkers
Future Collaborators
Marjolein van der Meulen, PhD
Cornell Engineering School
Cornella Farnum, DVM, PhD
Cornell Veterinary College
Thomas Andriacchi, PhD
Stanford University Engineering School