Weight Reduction
In the absence of sufficient evidence, it is the opinion of the workgroup that in patients with symptomatic ankle osteoarthritis, weight reduction may improve patient reported outcomes and affect progression of OA symptoms.
CONSENSUS RECOMMENDATION Rationale
No studies meeting inclusion criteria were identified when evaluating the influence of weight reduction on patient reported outcomes and the progression of symptoms in patients with symptomatic ankle osteoarthritis (OA).
Clinical Implications:
Based on expert consensus:
- Weight reduction is an option to improve patient-reported outcomes, including pain, function, and quality of life, in patients with symptomatic ankle OA.
- The effect of weight reduction on the progression of symptomatic ankle osteoarthritis is unknown.
- In the absence of evidence against the use of weight reduction to prevent the progression of ankle OA in patients with symptomatic ankle OA, a discussion between the surgeon and the patient is required to determine if the patient is a suitable candidate for an initial trial period of this modality prior to other invasive interventions.
- Weight reduction should be integrated into a multimodal nonoperative management plan for patients with symptomatic ankle OA prior to surgical intervention.
Limitations:
- No primary studies specifically evaluated weight reduction and progression of symptomatic ankle OA.
- Despite established evidence on the effect of weight gain and weight loss on the progression of OA in other joints, like the knee, the long-term outcomes and disease progression after weight loss, or timing of invasive interventions are unknown.
Benefits and Harm:
- Potential benefits: Potential benefits of weight loss include symptom relief, improved function, improved overall quality of life, reduction in cardiovascular risks or thromboembolic events in the event of a surgical intervention, and potential delay of invasive interventions.
- Potential harms: Potential harm is minimal, including possible progression of symptoms, persistent pain and discomfort, and a possible delay in appropriate surgical intervention.
Cost-Effectiveness and Resource Utilization:
- Weight loss programs are universally available today and affordable.
- Modalities may include both non-pharmacologic and pharmacologic interventions.
- The only cost may involve patient commitment.
Future Research:
- Conduct randomized controlled trials examining the effect of weight loss on the progression of symptomatic ankle OA.
- Further research is needed to determine those patients with symptomatic ankle OA who are the best candidates for weight loss programs.
- Conduct long term observational and case controlled prospective studies on patient reported outcomes after a structured weight loss program in patients with symptomatic ankle OA.
- Assess cost-effectiveness of integration of a standard weight loss program in patients who present with symptomatic ankle OA.
- Long term prospective trials are also needed to define the effectiveness of weight loss programs based on patient reported outcomes and to define the stage at which a patient is no longer benefiting from this modality.
- Long term prospective trials are needed to examine the effects of GLP-1s on patient reported outcomes and adverse events.
Additional Citations Not Meeting Inclusion Criteria
- Solanki P et al. Association between weight gain and knee osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2023 Mar;31(3):300-316. doi: 10.1016/j.joca.2022.10.023. Epub 2022 Nov 26. PMID: 36511280.