抄録
It is reported that bariatric surgery is effective in patients with morbid obesity, especially when there is difficulty in weight reduction or rebound phenomenon from therapy including internal medicine. Generally orthopedic operations for patients with knee osteoarthritis (both sides) and a high body mass index (BMI) over 50 kg/m2, have a risk of post-operative complications and sometimes functional improvement cannot be expected. We report here a case where total knee arthroplasty (TKA) was successfully performed for both sides after the weight reduction by laparoscopic sleeve gastrectomy (LSG). A 60-year-old morbidly obese male (BMI 50.8 kg/m2) was referred for bariatric surgery consultation. The patient complained of continuous severe knee joint pain, and was ordered to undergo weight reduction by an orthopedic surgeon before performing TKA, and then introduced to our hospital. Past and present illness included epilepsy, and accompanied with obesity-related complications; hypertension, dyslipidemia, fatty liver, sleep apnea syndrome, and type 2 diabetes (border-line). The educational admission was conducted aiming to reduce the risk of LSG and learn adequate lifestyles for weight reduction therapy. By the team medical treatment for weight reduction, including LSG, the operation was successful and his post-operative condition was maintained; BW 84 kg 8 month after LSG, a 58 kg reduction from the first visit. Ten months after LSG, a left side TKA was performed, and 4 months later, a right side TKA performed. After LSG, obesity-related complications were markedly improved. Furthermore, after TKA, knee pain was relieved, knee joint swelling disappeared, and his walking distance was extended. This case of morbid obesity showed that successful weight reduction was obtained by pre-performing LSG, thus reducing the risk of TKA and protecting against complications, and the activity of daily life and quality of life was improved by as a result of the team medical treatment.
