Obese patients suffering from osteoarthritis to the hip joint are helped by treatment concentrating on exercise and losing weight. Despite the recommendations of international guidelines, in only 10% of the cases this treatment is prescribed by the GP. UMCG researcher Nienke Paans has shown that a combined exercise and weight loss program before hip replacement can improve the physical functioning of obese patients with hip osteoarthritis and reduce pain. Paans also recommends more attention to exercise and losing weight after hip replacement. The date for completing her PhD qualification concerning her research in Medical Science has been set for 20 June 2012.
Patients suffering from osteoarthritis of the hip joint are treated by their GPs for about 7 years before they get an artificial hip. Paans established this by using data from 30,000 patients in a medical registration network of GPs over a period of 10 years, 1998-2008.
Patients with osteoarthritis of the hip are at risk to end up in a vicious circle. ‘If walking hurts due to osteoarthritis, people tend to reduce the amount of exercise they take and remain in their chairs. That increases the chance of gaining weight. This lack of exercise, and extra pressure on the hip joint due to the extra weight, will increase the symptoms’, explains Paans.
Paans analysed the effects of a combination program of exercise and weight loss in obese patients with hip osteoarthritis before they got a new hip. Participation in the program resulted in an improvement in the self-reported physical functioning. In addition, there was an improvement in the ability to walk, and the patients lost weight. After 8 months the participants were on average 5.6 kg lighter and their body fat had declined by 3.3 %, compared with the start of the program. ‘The combined program of exercise and weight loss means that we have more to offer to patients with osteoarthritis of the hip than just pain control’, explains Paans. ‘In addition, it can postpone hip replacement, which is beneficial because artificial hips have a lifespan of 10-15 years.’
Doctors and other specialists assume that obese patients will start to be physically active again after a hip operation, simply because they are once again able to. That could also lead to losing weight. Paans has established that this does not happen. ‘It is important that patients get physical active again and subsequently lose weight because obesity can affect the success of the operation. High body weight can lead to premature detachment of the prosthesis and that’s not what you want’, explains Paans.
Paans concludes that Dutch GPs should be more supported in their medical policy regarding osteoarthritis of the hip in the period preceding the hip operation. To this end the development of guidelines for GPs is important. Exercise and losing weight before and after the operation should be given an important place in these guidelines, according to Paans.
Nienke Paans (IJsselstein, 1974) studied biomedical sciences at Radboud University Nijmegen. She conducted her PhD research at the Department of Orthopaedics of the UMCG and within the framework of the Share research school. The title of Paans’s thesis is ‘Patients with hip osteoarthritis: body weight and lifestyle before and after arthroplasty.’
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