Change in body mass index during middle age affects risk of total knee arthoplasty due to osteoarthritis: A 19-year prospective study of 1003 women

Abstract

The evidence linking body mass index (BMI) to severe OA shows a strong association in the knee. There are limited data exploring the effect of BMI on the risk of joint arthroplasty in a healthy population with long periods of follow up. We compared the self-reported BMI at age 20, measured BMI at baseline, year 5 and year 10 with the year 19 risk of total knee arthroplasty (TKA) in a well-described, population based cohort of healthy women. A total of 733 women attended the 19th year visit, of whom 31 underwent TKA and 676 were used as a control group after 26 were removed for having hip arthoplasty.Using logistic regression, an increase in 1 unit of BMI at baseline was associated with a 10.5% increased risk of TKA (p = 0.017) and at year 5 the increased risk is 8.6% (p = 0.042). When adjusted for baseline age and smoking, baseline BMI was the only significant predictor of TKA at 10.0% with p = 0.024. There was no significant association at 10 years or for change in BMI over time.In this prospective, population based study, BMI predicted the risk of TKA for OA. The risk was greatest at baseline when the patients were in middle age suggesting that this is the most important time to target weight reduction interventions.

Strategies for the prevention of knee osteoarthritis

“…28 As well as being overweight or obese, weight gain is associated with the risk of receiving a total knee replacement. 31,32 Few data exist on the association of obesity with knee pain. In a cohort of 594 women, BMI at baseline was associated with self-reported knee pain 14 years later.…”

“…31 The results of other studies have shown increased risk of knee OA or total knee replacement in association with weight gain, but these studies were underpowered to detect reduced risk with weight loss. 32,33 The evidence suggests that obesity leads to knee OA and pain, and that weight loss will reduce both clinical OA and knee pain. Weight loss is achievable with the help of various interventions, and although maintenance of reduced weight is difficult, modifiable predictors have been identified (Box 1).…”

Bariatric Orthopaedics: Total Knee Arthroplasty in Super-obese Patients (BMI > 50 kg/m2). Survivorship and Complications

“…It is associated with an increase in medical comorbidities including hypertension, coronary artery disease, diabetes, and degenerative joint disease [7,32]. These patients potentially may be at increased risk for having osteoarthritis develop, and may need TKA at an earlier age [6,26]. However, surgical interventions in these patients may be associated with more technically demanding procedures and higher complication rates [3].…”

Body Mass Index and Functional Mobility Outcome Following Early Rehabilitation After a Total Knee Replacement: A Retrospective Study in Taiwan

“…These findings are consistent with those of previous studies. Nicholls et al observed that BMI is the strongest predictor for requiring a TKR in middle-aged patients, and that an increase in the BMI of 1 unit at baseline (median age 59 years) is associated with a 10.5% increased risk of TKR during 19-year followup (1). In a study by Gandhi et al, obese patients who required and underwent joint replacement surgery were 7.9 years younger than the nonobese patients (61).…”

“…Obesity is a modifiable risk factor for knee osteoarthritis (OA) and may contribute to the need for a total knee replacement (TKR) (1)(2)(3). The risk of developing degenerative joint disease increases 36% for every 2-unit (5 kg) increase in body mass index (BMI) (4).…”