Comparative Analysis of Knee Replacement Surgery who follow up by Physical Therapy and Intra-articular Steroid Injections for Obese Patients.
AJTES Vol 7, No 2, July 2023
Avdulaj E. - Comparative Analysis of Knee Replacement Surgery who follow up by Physical Therapy and Intra-articular Steroid Injections for Obese Patients


knee osteoarthritis,
knee replacement
knee corticosteroid injection
physical therapy

How to Cite

Avdulaj, E. (2023). Comparative Analysis of Knee Replacement Surgery who follow up by Physical Therapy and Intra-articular Steroid Injections for Obese Patients. Albanian Journal of Trauma and Emergency Surgery, 7(2), 1300-1303.


Knee osteoarthritis (KOA) is the most common chronic articular disease, and its prevalence has doubled since the mid-20th century. It affects 16% of the adult population over 50 years of age in the post-industrial era [1].

Obesity is one of the only modifiable risk factors for both incidence and progression of Osteoarthritis (OA).[2]

Although OA was previously regarded as a disease of the elderly, its development starts much earlier than originally thought, and OA is ranked among the top 20 diseases in the 40–45 years age group [3].

This review aims to provide a comprehensive analysis of the outcomes of knee replacement surgery following up physical therapy, versus intra-articular steroid injections for obese patients (BMI >30)

The study design employed in this review is narrative, and articles published after 2010 from PubMed were considered for inclusion. The review examines the impact of each intervention on the complete regain of knee function in this specific population.

Through the analysis of relevant studies, this review seeks to inform clinical decision-making and guide the management of obese patients with knee osteoarthritis.


Based on the reviewed literature, knee replacement surgery appears to offer a better chance of achieving complete regain of knee function in obese patients (BMI >30) undergoing physical therapy compared to intra-articular steroid injections. However, the findings are limited by the availability of studies and the heterogeneity in the research methodologies.
Avdulaj E. - Comparative Analysis of Knee Replacement Surgery who follow up by Physical Therapy and Intra-articular Steroid Injections for Obese Patients


Wallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, Woods RJ, Lieberman DE. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A. 2017 Aug 29;114(35):9332-9336. doi: 10.1073/pnas.1703856114. Epub 2017 Aug 14. PMID: 28808025; PMCID: PMC5584421.

Flego A, Dowsey MM, Choong PF, Moodie M. Addressing obesity in the management of knee and hip osteoarthritis - weighing in from an economic perspective. BMC Musculoskelet Disord. 2016 May 26;17:233. doi: 10.1186/s12891-016-1087-7. PMID: 27229924; PMCID: PMC4882789.

Institute for Health Metrics and Evaluation. GBD Data Visualizations [online], (2015).

Lin X, Li H. Obesity: Epidemiology, Pathophysiology, and Therapeutics. Front Endocrinol (Lausanne). 2021 Sep 6;12:706978. doi: 10.3389/fendo.2021.706978. PMID: 34552557; PMCID: PMC8450866.

World Health Organization: Obesity and overweight. Fact Sheet No.311. accessed on November 20, 2012. 2013. Mar, Available from:

Anandacoomarasamy A, Fransen M, March L. Obesity and the musculoskeletal system. Curr Opin Rheumatol. 2009;21:71–7. [PubMed] [Google Scholar] [Ref list]

Brooks PM. Impact of osteoarthritis on individuals and society: how much disability? Social consequences and health economic implications. Curr Opin Rheumatol. 2002;14:573–7. [PubMed] [Google Scholar] [Ref list]

Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039-49. doi: 10.1002/art.1780290816. PMID: 3741515.

Hellevik, A. I., Johnsen, M. B., Langhammer, A., Baste, V., Furnes, O., Storheim, K., ... & Nordsletten, L. (2018). Metabolic syndrome as a risk factor for total hip or knee replacement due to primary osteoarthritis: a prospective cohort study (the HUNT study and the Norwegian Arthroplasty Register). Clinical epidemiology, 83-96.

Wittenauer, R., Smith, L., & Aden, K. (2013). Background paper 6.12 osteoarthritis. World Health Organisation.

Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord. 2001 May;25(5):622-7. doi: 10.1038/sj.ijo.0801585. PMID: 11360143.

Wehling P, Evans C, Wehling J, Maixner W. Effectiveness of intra-articular therapies in osteoarthritis: a literature review. Ther Adv Musculoskelet Dis. 2017 Aug;9(8):183-196. doi: 10.1177/1759720X17712695. Epub 2017 Jun 20. PMID: 28835778; PMCID: PMC5557186.

Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res. 2018 Oct 5;11:2189-2196. doi: 10.2147/JPR.S154002. PMID: 30323653; PMCID: PMC6179584.

Williams D.P., Price A.J., Beard D.J., Hadfield S.G., Arden N.K., Murray D.W., Field R.E. The effects of age on patient-reported outcome measures in total knee replacements. Bone Joint J. 2013;95–b:38–44. doi: 10.1302/0301-620X.95B1.28061. [PubMed] [CrossRef] [Google Scholar] [Ref list]

Clement N.D., MacDonald D., Howie C.R., Biant L.C. The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more. J. Bone Joint. Surg. Br. 2011;93:1265–1270. doi: 10.1302/0301-620X.93B9.25962.

Jacobs CA, Christensen CP. Correlations between knee society function scores and functional force measures. Clin Orthop Relat Res. 2009;467:9. [PMC free article] [PubMed] [Google Scholar] [Ref list]

Mizner RL, Petterson SC, Clements KE, Zeni JA Jr, Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty. 2011 Aug;26(5):728-37. doi: 10.1016/j.arth.2010.06.004. Epub 2010 Sep 20. PMID: 20851566; PMCID: PMC3008304.

Maly MR, Costigan PA, Olney SJ. Determinants of self-report outcome measures in people with knee osteoarthritis. Arch Phys Med Rehabil. 2006;87:1. [PubMed] [Google Scholar] [Ref list]

Stratford PW, Kennedy DM. Performance measures were necessary to obtain a complete picture of osteoarthritic patients. J Clin Epidemiol. 2006;59:2. [PubMed] [Google Scholar] [Ref list]

Liu, S. H., Dubé, C. E., Eaton, C. B., Driban, J. B., McAlindon, T. E., & Lapane, K. L. (2018). Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis. The Journal of rheumatology, 45(9), 1316–1324.

Hirsch, G., O'Neill, T. W., Kitas, G., Sinha, A., & Klocke, R. (2017). Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis - an observational study. BMC musculoskeletal disorders, 18(1), 44.

Liao, C. D., Huang, Y. C., Chiu, Y. S., & Liou, T. H. (2017). Effect of body mass index on knee function outcomes following continuous passive motion in patients with osteoarthritis after total knee replacement: a retrospective study. Physiotherapy, 103(3), 266–275.

Mahendira L, Jones C, Papachristos A, Waddell J, Rubin L. Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis. Int Orthop. 2020 Jan;44(1):77-83. doi: 10.1007/s00264-019-04405-y. Epub 2019 Sep 13. PMID: 31520177; PMCID: PMC6938792.

Shannak O, Palan J, Esler C. A regional registry study of 216 patients investigating if patient satisfaction after total knee arthroplasty changes over a time period of five to 20years. Knee. 2017;24(4):824–828. doi: 10.1016/j.knee.2017.03.005. [PubMed] [CrossRef] [Google Scholar]

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.