LSTR

1. T E R R LSTR Osteoarthritis and Obesity Chris C-T Chen, PhD Shevaun Doyle, MD Daniel Green, MD Howard Hillstrom, PhD Hollis Potter, MD Peter A. Torzilli, PhD Hospital for Special Surgery New York City, NY

3. Self-assessed All types

5. Self-assessed ~21 million Clinical OA

6. What affect does obesity have on osteoarthritis? Obesity and osteoarthritis in knee, hip and/or hand Grotle et al. BMC Musculoskelet Disord (2008) In a 1994 Norwegian study of 1854 people aged 24-76 yrs • At 10-years follow-up high BMI (> 30) was associated with • Knee OA (OR 2.81; 95%CI 1.32-5.96) • Hand OA (OR 2.59; 1.08-6.19) • But not Hip OA (OR 1.11; 0.41-2.97)

7. Lifetime risk of symptomatic knee osteoarthritis Murphy et al. , A&R (2008) • 3,068 participants, Johnston County Osteoarthritis Project • Black and white women and men age 45+ years rural NC • Radiographic, sociodemographic, and symptomatic knee • Baseline (1990-1997) and first followup (1999-2003) • Symptomatic knee OA risk was 44.7% • Knee injury had a lifetime risk of 56.8% • Risk increased with increasing BMI • Risk of 66% among those who were obese

8. Percent of malaligned knees with OA progression 9.2%22.3%48.7% Knee Osteoarthritis, Body Weight and Joint Alignment Felson et al., Arthritis & Rheumatism (2004) Patient Population Knees OA Progression 90/394 Age 66.4±9.4 yrs Women 41.0% BMI 30.6±4.7 kg/m2 Median Alignment 2.1o varus Varus/Neutral/Valgus 67%/7%/26% Progression of knee OA via Joint Space Narrowing on Radiographs For each 2-unit increase in BMI, there was an 8% increase in the risk of progression (odds ratio=1.08, p=0.03)

9. Childhood Orthopedic Diseases Linked to Obesity • Genuvalgum • Slipped Capital Femoral Epiphysis (SCFE) • Blount’s Disease (tibia vara) Blount’s Disease

10. Orthopedic Complications of Overweightin Children and AdolescentsTaylor, E.D. et al. (2006) Pediatrics Children (93; <12 yrs) and Adolescents (242; 12-18 yrs) • 227 overweight (BMI>95th percentile) age 12.6±2.7 • 128 non-overweight (5th-95th percentile) age 11.8±2.9 Most common joint compliant was knee pain 6.6% overweight vs. 2.3% non-overweight In adolescents (12-18 yrs) - 18.3% overweight vs. 4.8% non-overweight Taylor, E.D. et al. (2006). Orthopedic complications of overweight in children and adolescents. Pediatrics. 117 (6): 2167-2174

11. Tibial Growth Plate and Lower Extremity Alignment • 159 overweight vs. 91 non-overweight • Tibial growth plate – tibial axial alignment • Femoral - tibial axial alignment Tibial-Growth Plate Alignment Valgus alignment Overweight > non-overweight Femoral-Tibial Alignment Not different Tibial-Growth Plate Alignment Fem-Tib Alignment Taylor, E.D. et al. (2006). Orthopedic complications of overweight in children and adolescents. Pediatrics. 117 (6): 2167-2174

12. Obesity and Lower Extremity Malalignment Genu valgum “A major unanswered question in the study of growth plate cellular function is the extent to which chondrocytic activity is also modulated by the biomechanical environment of the growth plate” Cornelia E. Farnum (Cells Tissues Organs 2000)

13. Stapling is a successful way to surgically correct valgus and varus deformities caused by unequal growth rates across a given physis. Treatment of Genuvalgum Surgical Options for Correcting Malalignment

14. Obesity, OA and Children • Only 19 papers found from 1999-2008 Effects of childhood obesity on three-dimensional knee joint biomechanics during walking Gushue, Houck and Lerner, A. L., J Pediatr Orthop (2005) • During early stance overweight children had • Lower peak knee flexion angle • Higher peak internal knee abduction moment • Overweight children may develop a gait adaptation • leading to increased joint loads and high contact stress • Childhood obesity may impart a greater risk for the • development of osteoarthritis due to repetitive high stress

15. T E R R Multiscale Modeling Changes in joint mechanics may predispose the joint to develop osteoarthritis Higher Stress Shift in Location Changes in joint mechanics may alter the normal metabolic balance Andriacchi (2004) Annals of Biomedical Engineering

16. Lower Extremity Alignment, Gait, and Joint Pathophysiology in Overweight and Normal Weight Children Co-PIs: Howard Hillstrom, PhD HSS Christopher Chen, PhDHSS Alejandro Diaz, MD Weill-Cornell Mary J. Ward, PhD Weill-Cornell Maura D. Frank, MD Weill-Cornell Daniel Green, MD HSS Co-PIs: Peter Torzilli, PhD HSS Mary Goldring, PhD HSS Sherry Backus, PT, DPT HSS Sarah Shultz, PhD Temple

17. Study the role of joint malalignment and BMI in overweight and normal weight children in the development of osteoarthritis • Motion analysis of gait and joint mechanics • Systemetic biomarkers for OA and bone pathophysiology

18. Obesity, OA and Children Wish List • Biomechanical • Joint alignment • Joint kinematics (motion) • Joint dynamics (contact stresses • Imaging (hard and soft tissues) • Radiographs • MR Imaging • Biological (hard and soft tissues) • Genetic • Systemic • Biomarkers

19. Future Collaborators Marjolein van der Meulen, PhD Cornell Engineering School Cornella Farnum, DVM, PhD Cornell Veterinary College Thomas Andriacchi, PhD Stanford University Engineering School