Potential underutilisation of weight loss medications in obese patients with knee osteoarthritis.

IF 2 4区医学 Q3 SURGERY

Annals of the Royal College of Surgeons of England Pub Date : 2026-08-06 DOI:10.1308/rcsann.2026.0063

N Badhe, C Busby, T Kurien, B A Marson

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引用次数: 0

Abstract

Introduction: Obesity is a major risk factor for knee osteoarthritis (OA), contributing to earlier symptomatic onset, increased pain severity and greater lifetime disability. Despite guidance that weight alone should not limit access to total knee arthroplasty (TKA), body mass index (BMI) thresholds are applied widely in clinical practice. This study investigated the glucagon-like peptide-1 (GLP-1) receptor agonist (RA) use among obese OA patients awaiting TKA and evaluated the influence of BMI on access to TKA.

Methods: A 30% random sample of a single-centre TKA waiting list (n = 300) in August 2025 was analysed. Data extracted included age, sex, BMI, time on waiting list, surgical listing status, comorbidities and use of weight loss interventions. Patients were stratified by BMI category (<35, 35-40, >40) and sex.

Results: Median BMI was 33.0 [27.9-38.0], with 120 patients (40%) classified as obese (BMI ≥35). Among obese patients, 45% were initially denied or conditionally listed for surgery, rising to 74.1% for BMI >40. Only 13 obese patients (10.8%) were taking GLP-1 RAs, despite extensive eligibility. Female patients had a higher average BMI (p = 0.049) and faced higher denial rates than male patients (52% vs 28%, p = 0.013). Most obese patients (n = 102) had ≥3 comorbidities, often including diabetes (n = 22) and obstructive sleep apnoea (n = 26).

Conclusion: Current pathways for managing obese patients with knee OA are inadequate. GLP-1 RAs may offer a promising solution to help reduce barriers to surgery. Further research is needed to determine whether GLP-1 RAs could help reduce the progression of OA and need for TKA.

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肥胖膝骨关节炎患者减肥药的潜在利用不足。

肥胖是膝骨关节炎（OA）的主要危险因素，有助于早期症状发作，增加疼痛严重程度和更大的终身残疾。尽管指导认为体重本身不应该限制全膝关节置换术（TKA），但体重指数（BMI）阈值在临床实践中被广泛应用。本研究探讨胰高血糖素样肽-1 （GLP-1）受体激动剂（RA）在等待TKA的肥胖OA患者中的使用情况，并评估BMI对TKA获得的影响。方法：对2025年8月单中心TKA候诊名单（n = 300）进行30%随机抽样分析。提取的数据包括年龄、性别、BMI、等待名单时间、手术名单状态、合并症和减肥干预措施的使用。患者按BMI分类（40）和性别分层。结果：中位BMI为33.0[27.9-38.0]，120例（40%）患者为肥胖（BMI≥35）。在肥胖患者中，45%的患者最初被拒绝或有条件地列入手术名单，而BMI指数为40的患者比例上升至74.1%。只有13名肥胖患者（10.8%）服用GLP-1 RAs，尽管有广泛的资格。女性患者的平均BMI （p = 0.049）高于男性患者（52% vs 28%, p = 0.013），并且面临更高的拒绝率。大多数肥胖患者（n = 102）有≥3种合并症，通常包括糖尿病（n = 22）和阻塞性睡眠呼吸暂停（n = 26）。结论：目前治疗肥胖膝关节OA患者的途径是不充分的。GLP-1 RAs可能提供一个有希望的解决方案，帮助减少手术障碍。GLP-1 RAs是否有助于减少OA的进展和TKA的需要还需要进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of the Royal College of Surgeons of England Medicine-Surgery

CiteScore

2.40

自引率

0.00%

发文量

316

期刊介绍： The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November. The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.