Obesity and prayer damages knees

Knee replacement operations are on the rise in the UAE because of rising obesity rates and degenerative joint problems caused by praying five times a day, doctors say.

A lifetime of regular prayer, plus increasing levels of obesity in the UAE are significant contributory factors in the rise of Muslims requiring knee-replacement surgery, according to local doctors. Jaime Puebla / The National
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ABU DHABI // Muslims in the UAE are among the most common sufferers of degenerative knee problems in the world because of soaring obesity rates and a kneeling-to-pray culture.

The practice of praying five times daily coupled with the pressure to joints by carrying excess weight is causing a parallel demand for knee-replacement operations, doctors have said.

“In the UAE, knee arthritis is incredibly common. That is to do with a kneeling lifestyle because they pray and they put a lot of pressure on the knees,” said Dr Peter Birch, a consultant orthopaedic and knee arthroplasty surgeon at Abu Dhabi’s Mafraq Hospital.

“We think that is one of the biggest causes of it. If you are kneeling several times a day for the whole of your life, you are putting a huge strain on a joint that is not designed for that.

“The interesting thing here is that the actual anatomy of the knee is different to non-kneeling countries. So because they kneel from a very early age we think it actually grows in a different shape because of the praying.”

While pressures to the knee by praying cannot be avoided, reducing other risk factors to joints such as obesity – a well-documented risk factor for the development of osteoarthritis – can help, said the 48-year-old Briton.

“If you already have a high-risk population, try to reduce the other risks by improving diet, improving weight and better managing the early problems that can go on to cause arthritis. Give the knee the best chance it has.”

Worldwide estimates suggest that demand for knee-replacement operations could soar by 600 per cent by 2030 with rising obesity levels thought to be a factor, Dr Birch said.

Arthritis is initially treated non-surgically, but total joint replacement often becomes necessary if the disease progresses, said Dr Khalaf Moussa, an orthopaedic surgeon at Dubai Bone and Joint Centre, at Dubai Healthcare City.

He estimates about 60 per cent of knee-replacement operations in the UAE are weight-related.

“A lot of people are becoming obese and of course that affects the knee joints and causes arthritis and so you have to do these knee replacements,” said Dr Moussa, 54, from Germany.

More than 66 per cent of men and 60 per cent of women in the UAE are now overweight or obese, according to a global study released earlier this year.

“Here, obesity is one of the major factors that causes this increasing trend in the number of these types of procedures. It is becoming quite common now.”

A sedentary lifestyle is also to blame, Dr Moussa said. “You see a lot of people sitting around all day and of course this puts a lot of pressure on the joints.”

A recent study published in the Journal of Bone and Joint Surgery found that total knee replacements more than tripled between 1993 and 2009 in the US and were much more prevalent among patients who were overweight or obese.

“In the past ten years there has been a remarkable increase in the incidences of these operations in the UAE,” said Dr Ahmed Maher Ibrahim, an orthopaedic specialist at Al Noor Hospital, in Abu Dhabi.

The 37-year-old Egyptian said there were many contributing factors including lifestyle habits, a lack of regular exercise and a sedentary lifestyle.

“Being overweight increases the load and the wear and tear on the joint,” Dr Ibrahim said.

“Some people are aware and try to find solutions for this by reducing their weight. But some others are completely ignorant.”

He said the demand had led to several specialised centres cropping up across the UAE.

Dr Muthusamy Veerabahu, a specialist in orthopaedic surgery at Abu Dhabi’s Burjeel Hospital, said obesity and praying each have a role to play in the increasing demand for knee surgery.

“People who are obese – it is not uncommon for these people to have osteoporosis.”

Obese patients, he said, were also more likely to fare worse after surgery. “Numerous studies show that obesity complicates the recovery and long-term success of knee-replacement surgery. Although many of my patients don’t want to wait for surgery, I have found it’s best to lose weight before the surgery if at all possible.”