Einfluss von Übergewicht und Adipositas auf den wachsenden und adulten Bewegungsapparat

Zusammenfassung

Belastungsabhängige Beschwerden des Haltungs- und Bewegungsapparates werden von übergewichtigen Patienten häufig beklagt. Neben funktionellen Behinderungen stellen strukturelle Veränderungen und Gelenkfehlstellungen, insbesondere der unteren Extremitäten und der Wirbelsäule, die häufigste Ursache der Beschwerden dar. Übergewicht ist ein wissenschaftlich klar belegter Risikofaktor zur Manifestation von Gelenkarthrosen im Erwachsenenalter. Aber bereits im Kindes- und Jugendalter bestehen klar belegte Zusammenhänge zwischen der Entwicklung pathologischer Fuß-, Beinachsen- und Hüftfehlstellungen und frühzeitig manifestem Übergewicht oder gar Adipositas. Selbst eine erhöhte Gefahr dieser Patientengruppe, sich im Alltag oder bei sportlichen Aktivitäten akut zu verletzen oder sich eine Fraktur zuzuziehen, konnte belegt werden. Der Einfluss von Adipositas auf das klinisch-funktionelle Ergebnis nach endoprothetischer Versorgung wird kontrovers diskutiert. Für die im Beitrag dargestellten Erkrankungen am wachsenden und adulten Skelett konnten Stammfettsucht und Übergewicht als Risikofaktoren identifiziert werden.

Summary

Obese adolescent patients freqently complain about load-dependend pain in the joints of the lower extremity or low back pain corresponding to functional disorders, malalignment and early structural changes. There is evidence of various structural and functional disorders of the lower extremities in case of early onset of obesity in the childhood. Furthermore, the prevalence of sport injuries and fractures is significantly increased in obese individuals compared with their normal-weight peers. In adults obesity is a known risk factor for early osteoarthritis in the knee and forefood deformities. There exists controversy on the effect of body mass index on clinical outcome after joint replacement procedures. This article gives an overview over muskuloskeletal disorders with known association to obesity on paediatric and adult patients.

Schlüsselwörter

Übergewicht - Adipositas - Bewegungsapparat

Keywords

Overweight - obesity - muskuloskeletal system

• Literatur

• 1 Andersen RE, Crespo CJ, Bartlett SJ. et al. Relationship between body weight gain and significant knee, hip and back pain in older Americans. Obes Res 2003; 11: 1159-1162.
• 2 Andrew JG, Palan J, Kurup HV. et al. Obesity in total hip replacement. J Bone Joint Surg Br 2008; 90 (04) 424-429.
• 3 Bell LM, Byrne S, Thompson A. et al. Increasing body mass index z-score is continuously associated with complications of overweight in children, even in the healthy weight range. J Clin Endocrinol Metab 2007; 92 (02) 517-522.
• 4 Blount WP. Tibia vara: osteochondrosis deformans tibiae. J Bone Joint Surg 1937; 19A: 1-8.
• 5 Bonet BSerra, Quintanar ARioja, Alavés MBuforn. et al. Presence of genu valgum in obese children: Cause or effect?. An Pediatr 2003; 58 (03) 232-235.
• 6 Bowditch MG, Villar RN. Do obese patients bleed more? A prospective study of blood loss at total hip replacement. Ann R Coll Surg Engl 1999; 81 (03) 198-200.
• 7 Bruckner L, Rosler P. Orthopaedic findings of the foot as related to age and body weight among women. ZFA 1981; 36 (01) 29-35.
• 8 Chan CL, Villar RN. Obesity and quality of life after primary hip arthroplasty. J Bone Joint Surg Br 1996; 78 (01) 78-81.
• 9 Cooper C, Inskip H, Croft P. et al. Individual risk factors for hip osteoarthritis: Obesity, hip injury, and physical activity. Am J Epidemiol 1998; 147: 516-522.
• 10 Davids JR, Huskamp M, Bagley AM. A Dynamic Biomechanical Analysis of the Etiology of Adolescent Tibia Vara. J Pediatr Orthop 1996; 16: 461-468.
• 11 Davis MA, Ettinger WH, Neuhaus JM. Obesity and osteoarthritis of the knee: evidence from the national health and nutrition examination survey (NHANES I). Semin Arthritis Rheum 1990; 20: 34-41.
• 12 de Sá ALPinto, de Barros PMHolanda, Radu AS. et al. Musculoskeletal findings in obese children. J Peadiatr Child Health 2006; 42 (06) 341-344.
• 13 Dowling AM, Steel JR, Baur LA. Does obesity influence foot structure and plantar pressure patterns in prepubescent children. Int J Obes Relat Metab Disord 2001; 25 (06) 845-852.
• 14 Dowling AM, Steel JR, Baur LA. What are the effects of obesity in children on plantar pressure distribution?. International Journal of Obesity 2004; 28: 1514-1519.
• 15 Engelhardt P. Epiphysiolysis of the femoral head: indications for the treatment of the contralateral hip at cessation of growth. Z Orthop 1990; 23: 262-265.
• 16 Faulkner A, Kennedy LG, Baxter K. et al. Effectiveness of hip prostheses in primary total hip replacement: a critical review of evidence and an economic model. Health Technol Assess 1998; 02 (06) 1-133.
• 17 Felson DT, Anderson JJ, Naimark A. et al. Obesity and knee osteoarthritis. The Framingham study. Ann Intern Med 1988; 109: 18-24.
• 18 Felson DT, Zhang Y, Anthony JM, Anderson JJ. et al. Weight loss reduces the risk for symtomatic knee osteoarthritis in women. Ann Intern Med 1992; 116: 535-539.
• 19 Fender D, Harper WM, Gregg PJ. Outcome of Charnley total hip replacement across a single health region in England: the results at five years from a regional hip register. J Bone Joint Surg Br 1999; 81 (04) 577-581.
• 20 Galbraith RT, Gelberman RH, Hajek PC. Obesity and decreased femoral anteversion in adolescence. J Orthop Res 1987; 05 (04) 523-528.
• 21 Garcia-Rodriguez A, Martin-Jemenez F, Carnero-Varo M. et al. Flexible flat feet in children: a real problem?. Pediatrics 1999; 103 (06) e84.
• 22 Gelberman RH, Cohen MS, Shaw BA. et al. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am 1986; 68 (07) 1000-1007.
• 23 Günther KP, Stürmer T, Sauerland S. et al. Prevalence of generalized osteoarthritis in patients with advanced hip and knee OA: the Ulm osteoarthritis Study. Ann Rheum Dis 1998; 57: 717-723.
• 24 Günther KP, Stürmer T, Trepte CT. et al. Häufigkeit gelenkspezifischer Risikofaktoren bei Patienten mit fortgeschrittener Cox- und Gonarthrose in der Ulmer Osteoarthrosestudie. Z Orthop 1999; 137: 468-473.
• 25 Hangai M, Kaneoka K, Kuno S. et al. Factors associated with lumbar intervertebral disc degeneration in the elderly. Spine J. 2007 Nov 21.
• 26 Harms S, Larson R, Sahmoun AE, Beal JR. Obesity increases the likelihood of total joint replacement surgery among younger adults. Int Orthop 2007; 31 (01) 23-26.
• 27 Hefti F. Achsenfehler an den unteren Extremitäten. Orthopäde 2000; 29: 814-820.
• 28 Heliövaara M, Mäkelä M, Impivaara O. et al. Association of overweight, trauma and workload with cox arthrosis. A health survey of 7217 persons. Acta Orthop Scand 1993; 64: 513-518.
• 29 Horan F. Obesity and joint replacement. J Bone Joint Surg Br 2006; 88 (10) 1269-1271.
• 30 Horn MR. Orthopädische Komorbidität bei Kindern und Jugendlichen mit Adipositas unter besonderer Berücksichtigung der Epiphysiolysis capitis femoris. Med. Promotion. 2002 Universität Ulm.
• 31 Ibrahim T, Hobson S, Beiri A, Esler CN. No influence of body mass index on early outcome following total hip arthroplasty. Int Orthop 2005; 29 (06) 359-361.
• 32 Jerosch J, Mamsch H. Fehlformen und Fehlhaltungen kindlicher Füße – eine Feldstudie bei 345 Schülern. Z Orthop 1998; 136 (03) 215-220.
• 33 Jerre R, Billing L, Hansson G, Wallin J. The contralateral hip in patients primarily treated for unilateral slipped upper femoral epiphysis. Long term follow up of 61 hips. J Bone Joint Surg Br 1994; 76: 563-567.
• 34 Jiganti JJ, Goldstein WM, Williams CS. A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop Relat Res 1993; 289: 175-179.
• 35 Jingushi S, Hara T, Sugioka Y. Deficiency of a parathyroid hormone fragment containing the midportion and 1,25-dihydroxyvitamin D in slipped capital femoral epiphysis. J Pediatr Orthop 1997; 17 (02) 216-219.
• 36 Jingushi S, Suenaga E. Slipped capital femoral epiphysis: etiology and traetment. J Orthop Sci 2004; 09: 214-219.
• 37 Jinks C, Jordan KP, Blagojevic M, Croft P. Predictors of onset and progression of knee pain in adults living in the community. A prospective study. Rheumatology 2008; 47: 368-374.
• 38 Karlson EW, Mandl LA, Aweh GN. et al. Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors. Am J Med 2003; 114 (02) 93-98.
• 39 Katz JN. Preferences, quality, and the (under)utilization of total joint arthroplasty. Med Care 2001; 39 (03) 203-205.
• 40 Kelsey JL, Keggi KJ, Southwick WO. The incidence and distribution of slipped femoral epiphysis in Connecticut and southwestern United States. J Bone Joint Surg 1970; 52A: 1203-1216.
• 41 Kessler S, Kafer W. Overweight and obesity: two predictors for worse early outcome in total hip replacement?. Obesity (Silver Spring) 2007; 15 (11) 2840-2845.
• 42 Loder RT. The demographics of slipped capital femoral epiphysis. An international multicenter study. Clin Orthop 1996; 322: 8-27.
• 43 Lubbeke A, Stern R, Garavaglia G. et al. Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis Rheum 2007; 15; 57 (02) 327-334.
• 44 Luhmann SJ, Rich MM, Schoenecker PL. Painful idiopathic rigid flatfoot in children and adolescents. Foot Ankle Int 2000; 21 (01) 59-66.
• 45 Manninen P, Riihimaki H, Heliovaara M, Makela P. Overweight, gender and knee osteoarthritis. Int J Obes Relat Metab Disord 1996; 20 (06) 595-597.
• 46 Marks R, Allegrante JP. Body mass indices in patients with disabling hip osteoarthritis. Arthritis Res 2002; 04 (02) 112-116.
• 47 McClung CD, Zahiri CA, Higa JK. et al. Relationship between body mass index and activity in hip or knee arthroplasty patients. J Orthop Res 2000; 18 (01) 35-39.
• 48 McLaughlin JR, Lee KR. The outcome of total hip replacement in obese and non-obese patients at 10– to 18-years. J Bone Joint Surg Br 2006; 88 (10) 1286-1292.
• 49 Mertz DP, Mertz A. Hallux rigidus arthrosis and gout. Fortschr Med 1982; 100 (11) 446-448.
• 50 Moran M, Walmsley P, Gray A, Brenkel IJ. Does body mass index affect the early outcome of primary total hip arthroplasty?. J Arthroplasty 2005; 20 (07) 866-869.
• 51 Murray AW, Wilson NIL. Changing incidence of slipped capital femoral epiphysis. A relationship with obesity?. J Bone Joint Surg (Br) 2008; 90-B: 92-94.
• 52 Namba RS, Paxton L, Fithian DC, Stone ML. Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 2005; 20 (01) (Suppl. 03) 46-50.
• 53 Nilsdotter AK, Petersson IF, Roos EM, Lohmander LS. Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study. Ann Rheum Dis 2003; 62 (10) 923-930.
• 54 Ninomiya S, Nagasaka Y, Tagawa H. Slipped capital femoral epiphysis: a study of 68 cases in the eastern half area of Japan. Clin Orthop 1976; 119: 172-176.
• 55 Noguchi Y, Sakamaki T. The Multicenter Study Committee of the Japanese Pediatric Orthopaedic Association. Epidemiology and demographic of slipped capital femoral epiphysis in Japan: a multicenter study by the Japanese Pediatric Orthopaedic Association. J Orthop Sci 2002; 07: 610-617.
• 56 Oliveria SA, Felson DT, Cirillo PA. et al. Body weight, body mass index and incident symptomatic osteoarthritis of the hand, hip and knee. Epidemiology 1999; 10: 161-166.
• 57 Olsen O, Vingard E, Köster M, Alfredsson L. Etiologic fractions for physical work load, sports and overweight in the occurrence of coxarthrosis. Scand J Work Environ Health 1994; 20: 184-188.
• 58 Patel VP, Walsh M, Sehgal B. et al. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am 2007; 89 (01) 33-38.
• 59 Perka C, Labs K, Muschik M, Buttgereit F. The influence of obesity on perioperative morbidity and mortality in revision total hip arthroplasty. Arch Orthop Trauma Surg 2000; 120 (5–6 267-271.
• 60 Poussa M, Schlenzka D, Yrjonen T. Body mass index and slipped capital femoral epiphysis. J Pediatr Orthop B 2003; 12 (06) 369-671.
• 61 Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br 1992; 74 (04) 525-527.
• 62 Riddiford-Harland DL, Steel JR, Storlien LH. Does obesity influence foot structure in prepubescent children?. Int J Obes Relat Metab Disord 2000; 24 (05) 541-544.
• 63 Rorabeck CH, Bourne RB, Laupacis A. et al. A doubleblind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. Clin Orthop Relat Res 1994; 298: 156-164.
• 64 Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons. J Bone Joint Surg Br Mar 1995; 77 (02) 254-257.
• 65 Sadr AO, Bellocco R, Eriksson K, Adami J. The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement. J Bone Joint Surg Br 2006; 88 (10) 1316-1320.
• 66 Schnitzler CM, Daniels ED, Mesquita JM, et al. Zachen GPD. et al. Bone disease in African children with slipped capital femoral epiphysis: histomorphometry of iliac crest biopsies. Bone 1998; 22 (03) 259-265.
• 67 Shiri R, Solovieva S, Husgafvel-Pursiainen K. et al. The association between obesity and the prevalence of low back pain in young adults: the Cardiovascular Risk in Young Finns Study. Am J Epidemiol 2008; 167 (09) 1110-1119.
• 68 Smith SL, Beckish ML, Winters SC. et al. Treatment of late-onset tibia vara using afghan percutaneous osteotomy and orthofix external fixation. J Pediatr Orthop 2000; 20 (05) 606-610.
• 69 Soballe K, Christensen F, Luxhoj T. Hip replacement in obese patients. Acta Orthop Scand 1987; 58 (03) 223-225.
• 70 Stickles B, Phillips L, Brox WT. et al. Defining the relationship between obesity and total joint arthroplasty. Obes Res 2001; 09 (03) 219-223.
• 71 Stovitz SD, Pardee PE, Vazquez G. et al. Musculoskeletal pain in obese children and adolescents. Acta Paediatr 2008; 97 (04) 489-493.
• 72 Stukenborg-Colsman C, Ostermeier S, Windhagen H. What effect does of obesity have on the outcome of total hip and knee arthroplasty. Review of the literature. Orthopade 2005; 34 (07) 664-667.
• 73 Stürmer T, Günther KP, Brenner H. Obesity, overweight and patterns of osteoarthritis: the Ulm Osteoarthritis Study. J Clin Epidemiol 2000; 53: 307-313.
• 74 Sturmer T, Dreinhofer K, Grober-Gratz D. et al. Differences in the views of orthopaedic surgeons and referring practitioners on the determinants of outcome after total hip replacement. J Bone Joint Surg Br 2005; 87 (10) 1416-1419.
• 75 Taylor ED, Theim KR, Mirch MC. et al. Orthopedic complications of overweight in children and adolescents. Pediatrics 2006; 117 (06) 2167-2174.
• 76 The Economic Costs of Obesity. Canberra: Access- Economics/Diabetes Australia; 2006
• 77 Thompson GH, Carter JR. Late-onset tibia vara (Blount’s desease). Current concepts. Clin Orthop 1990; 255: 24-35.
• 78 Weiner D. Pathogenesis of slipped capital femoral epiphysis : current concepts. J Pediatr Orthop (Part B) 1996; 05: 67-73.
• 79 Wendelboe AM, Hegmann KT, Biggs JJ. et al. Relationships between body mass indices and surgical replacements of knee and hip joints. Am J Prev Med 2003; 25 (04) 290-295.
• 80 Wenger DR, Mickelson M, Maynard JA. The evolution and histopathology of adolescent tibia vara. J Pediatr Orthop 1984; 04 (01) 78-88.
• 81 White GR, Mencio GA. Genu valgum in children: Diagnostic and therapeutic alternatives. J Am Acad Orthop Surg 1995; 03: 275-283.
• 82 www.who.int/medicentre/factsheets/fs311/en/print.html.
• 83 www.jru.orthop.gu.se.
• 84 Zwiauer K, Wabitsch M. Relativer Body-mass- Index (BMI) zur Beurteilung von Übergewicht und Adipositas im Kindes- und Jugendalter. Mschr Kinderh 1997; 145: 1312-1318.