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ways to support and improve care for Albertans living with osteoarthritis and obesity, a workshop in June 2017 will bring stakeholders together across the continuum of care to engage in evidence-informed discussion and planning strategies. This white paper and knowledge synthesis was designed to provide a foundation of current evidence to anchor discussions and decisions moving forward. Methods The knowledge synthesis amalgamates review articles on hip and knee osteoarthritis treatment in adults with obesity, published from January 2010 to January 2017. Key points and evidence gaps are collected from included articles and presented as recommendations for both non-surgical (conservative management) and surgical management of osteoarthritis in adults with obesity. Results The evidence supports non-surgical management that combines diet and physical activity interventions, resulting in improved pain and physical function (regardless of changes to body weight). Separately, weight loss of 5-10% of body weight is associated with improvements in clinical symptoms, however this degree of weight loss may be difficult to attain. Importantly, benefits are still derived without weight loss. Additionally, there is limited evidence on the most appropriate types of physical activities for adults with osteoarthritis and obesity. For surgical management, the evidence indicates increased risk of surgical infections when body mass index (BMI) is above 30 kg/m2 , particularly in knee arthroplasty, although limitations in the quality and methodology of the research indicate further clarification is necessary. Weight loss before surgery does not decrease infection risk, and there is a lack of information on the impact of extended surgical delays. Using an absolute value of BMI as a cut-off for surgery is not recommended, but shared decision making with the individual patient is strongly recommended, incorporating discussion of risk factors, medical history, disability, and surgical expectations. 4 Bone and Joint Health Strategic Clinical Network Introduction Osteoarthritis prevalence across Canada has increased in conjunction with an aging population and rising rates of obesity1,2 . As one of the leading causes of disability for Canadians3 , osteoarthritis can result in joint pain and stiffness that significantly impacts quality of life, mobility, productivity and healthcare resource use4 . Obesity is a risk factor for development and progression of osteoarthritis, and both osteoarthritis and obesity share interrelated inflammatory, metabolic and biomechanical pathways5,6 . Both conditions are complex, chronic, progressive, and challenging to treat, especially when they co-occur in a patient. The Problem The increased prevalence of both osteoarthritis and obesity has resulted in elevated demand for health services, including early hip and knee joint replacement in an increasingly younger demographic7 . Clinicians are challenged in identifying and delivering effective optimal treatment approaches for osteoarthritis in patients with obesity. Additionally, patients who live with osteoarthritis and obesity are confronted with navigating their health journeys in a health care environment where these conditions are treated individually rather than in an integrated manner. Addressing the Problem Workshop To address these challenges, the Bone and Joint Health Strategic Clinical Network (BJH SCN) is organizing a workshop on June 13 & 14, 2017. The purpose of the workshop is to provide an opportunity for a broad range of stakeholders in Alberta with direct experience and/or knowledge of this topic (including patients, researchers, health professionals, health administrators, policy makers, and industry representatives) to engage in an evidence-informed discussion to identify pragmatic ways of moving forward to support Albertans living with osteoarthritis and obesity across the continuum of care. A key principle for this workshop approach is shared responsibility in health and the health care system, therefore stakeholder engagement throughout the continuum of care will ensure success is clearly defined and achievable. The workshop will take place over two days. Day 1 (June 13) will be focused on prevention and management (non-surgical) approaches. Day 2 (June 14) will be focused on surgical care, specifically arthroplasty related to osteoarthritis in patients with obesity. The detailed program is available in Appendix 1. White paper The BJH SCN has conducted a knowledge synthesis to inform this white paper, providing an evidence-based foundation for workshop discussions. This paper summarizes current research evidence and recommendations for hip and knee osteoarthritis treatment in adults with obesity. 5 Bone and Joint Health Strategic Clinical Network Background Osteoarthritis Definition Osteoarthritis is a chronic, progressive, and irreversible degenerative joint disease that affects more than 4 million Canadians, with those numbers expected to double in the next 30 years8 . Multiple risk factors are associated with osteoarthritis development, including age, sex, obesity, genetics and joint trauma9 , yet the underlying mechanisms that impact disease initiation and progression are still unclear. Joint instability, trauma, muscle weakness and increased joint loading due to higher body weight can affect the
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