Studies have shown that for people who are overweight, even a modest amount of weight loss can have a significant effect on knee OA pain. But for those who have more than a modest amount of weight to lose or for whom excessive weight is a taking a toll on more than the knees, a growing body of research shows bariatric surgery can help relieve the pain of OA as well as some of the health problems that often accompany the disease.

What is Bariatric Surgery?

Bariatric surgery is surgery designed specifically to promote weight loss. In the U.S., the three most commonly performed bariatric procedures are:

  • Laparoscopic gastric banding, which involves placing a plastic band around the upper end of the stomach. This greatly reduces food intake by decreasing the amount of food it takes to make you feel full.
  • Vertical sleeve gastrectomy, which involves stapling off and removing a portion of the stomach, leaving only a small pouch for food. Like laparoscopic gastric banding it reduces food intake by decreasing the amount it takes to make you to feel full.
  • Gastric bypass, which involves stapling off the upper portion of the stomach to create a small pouch and then dividing the small intestine attaching one end of the intestine to the pouch and the other farther down on the intestine. Gastric bypass works in two ways: by decreasing the amount you can eat and decreasing absorption of calories from the food you eat. It is the most complex, but most effective form of weight-loss surgery.

Relief for Painful Joints

Several studies have shown that the weight loss from bariatric surgery is effective against OA pain, particularly of the knee.

In one study presented at a 2011 meeting of the American Orthopaedic Society for Sports Medicine researchers at Penn State College of Medicine followed 24 patients with clinical and radiographic evidence of knee undergoing bariatric surgery. The patients, who ranged in age from 30 to 67, completed a survey evaluating pain, stiffness and physical function at six and 12 months after surgery.

In the six-month survey, the patients, who had lost an average of 57 pounds, reported significant improvement in knee pain and stiffness, physical function, quality of life and activities of daily living – without medications, says researcher Christopher Edwards, a fourth-year medical student at Penn State.

In a separate study, researchers at New York University reviewed the charts of 264 patients who underwent bariatric surgery – 192 who had laprascopic gastric banding, 53 who had gastric bypass and 19 who had vertical sleeve gastrectomy. At an average follow-up of 17.2 months, patients had lost 28.4 percent of their excess weight. In the process, many had also lost their arthritis pain.

Seventy-one percent of those undergoing gastric bypass, 63 percent with sleeve gastrectomy and 51 percent who had the lap band reported a resolution of knee OA pain.

While bariatric surgery can help people lose the weight they need to relieve OA pain, naturally the surgery does not reverse the arthritis itself, says Michael A. Edwards, MD, chief of the Minimally Invasive and Digestive Surgery Section at Georgia Health Sciences University in Augusta. But even when joint damage has progressed to the point of requiring joint replacement, bariatric surgery can help. “If you talk to our orthopaedic colleagues, they don’t feel that they are doing patients a service to do a joint replacement if they are morbidly obese,” he says. “It is better to address weight loss before surgery."