Patients with the most to gain from weight loss

SIR – Professor Phil Turner, one of the country’s leading orthopaedic surgeons, describes the impact on patients as hip and knee replacements have been postponed over the last five months (report, August 30).

End-stage arthritis is not adequately treated with painkillers; indeed, prolonged opiate use is neither effective nor good for the patient. Thus, it is imperative that the prolonged waiting times for arthritis surgery be addressed. However, while waiting for surgery, overweight and obese patients should take the opportunity to reduce their pain by losing weight.

Clinical trial evidence from Denmark shows that overweight and obese people with knee osteoarthritis can lose about 10kg of body weight (one and a half stone) using total diet replacement formula diets and maintain that weight loss, with a large reduction in symptom scores – especially for pain. Reduction in knee pain improves sleep quality and makes movement easier. We have seen patients able to play with their grandchildren again and get back on their bicycles to cycle around Copenhagen.

In Denmark we have demonstrated that weight loss before knee replacement surgery is feasible. In Britain, a feasibility trial – which combined weight loss with analgesia, insoles, and exercise – is under analysis. This type of dietary intervention is already in use in Scotland and in an NHS England trial for diabetes remission. Dr Anthony Leeds Senior Fellow Professor Henning Bliddal Director, Parker Arthritis Institute Copenhagen, Denmark Professor Hamish Simpson Consultant Orthopaedic Surgeon, University of Edinburgh