Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading

Lianzhi Chen; Jessica Jun Yi Zheng; Guangyi Li; Jun Yuan; Jay R Ebert; Hengyuan Li; John Papadimitriou; Qingwen Wang; David Wood; Christopher W Jones; Minghao Zheng

doi:10.1016/j.jot.2020.05.001

Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading

J Orthop Translat. 2020 May 15:24:66-75. doi: 10.1016/j.jot.2020.05.001. eCollection 2020 Sep.

Authors

Lianzhi Chen¹, Jessica Jun Yi Zheng², Guangyi Li³, Jun Yuan^{1

4}, Jay R Ebert⁵, Hengyuan Li⁶, John Papadimitriou^{1

7}, Qingwen Wang⁸, David Wood¹, Christopher W Jones^{9

10}, Minghao Zheng^{1

4}

Affiliations

¹ Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
² Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
³ Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
⁴ Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.
⁵ School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia.
⁶ Department of Orthopedics, Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang, China.
⁷ Pathwest Laboratories, Perth, Western Australia, Australia.
⁸ Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
⁹ Fiona Stanley Hospital Group, Perth, Western Australia, Australia.
¹⁰ Curtin University Medical School, Perth, Western Australia, Australia.

Abstract

Obesity-related osteoarthritis (OA) is a complex, multifactorial condition that can cause significant impact on patients' quality of life. Whilst chronic inflammation, adipocytokines and metabolic factors are considered to be important pathogenic factors in obesity related OA, there has been limited investigation into the biomechanical impact of obesity on OA development. This review aims to demonstrate that mechanical factors are the major pathological cause of obesity-related OA. The effect of obesity on pathological changes to the osteochondral unit and surrounding connective tissues in OA is summarized, as well as the impact of obesity-related excessive and abnormal joint loading, concomitant joint malalignment and muscle weakness. An integrated therapeutic strategy based on this multi-factorial presentation is presented, to assist in the management of obesity related OA.

The translational potential of this article: Despite the high prevalence of obesity-related OA, there is no specific guideline available for obesity-related OA management. In this review, we demonstrated the pathological changes of obesity-related OA and summarized the impact of biomechanical factors by proposing a hypothetical model of obesity-related OA change. Therapeutic strategies based on adjusting abnormal mechanical effects are presented to assist in the management of obesity-related OA.

Keywords: Biomechanics; Clinical management; Mechanical loading; Obesity; Osteoarthritis; Pathogenesis.

Publication types

Review