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Epidemiology and Population Health

Weight loss is associated with reduced risk of knee and hip replacement: a survival analysis using Osteoarthritis Initiative data

International Journal of Obesity volume 46, pages 874–884 (2022)Cite this article

Subjects

Abstract

Objective

To describe the association between body weight change and the risk of knee replacement and hip replacement.

Design

Time-to-event survival analysis from a population-based cohort of participants who had or were at risk of clinically significant knee osteoarthritis at baseline.

Setting

Data from the Osteoarthritis Initiative (OAI), which collected data from four clinical centres in the United States.

Participants

A total of 8069 knees from 4081 participants, and 8076 hips from 4064 participants (59.3% female) aged 45–79 years, with mean ± SD body mass index (BMI) of 28.7 ± 4.8 kg/m2, were included in the knee and hip analyses, respectively.

Exposure

Body weight change from baseline as a percentage of baseline at repeated follow-up visits over 8 years.

Main outcome measure

Incidence of primary knee or hip replacement during 8-year follow-up.

Results

Body weight change had a small, positive, linear association with the risk of knee replacement (adjusted hazard ratio [HR] 1.02; 95% confidence interval [CI] 1.00–1.04). Body weight change was also positively and linearly associated with the risk of hip replacement in hips that were persistently painful at baseline (adjusted HR 1.03; 95% CI 1.01–1.05), but not in hips that were not persistently painful at baseline. There were no significant interactions between body weight change and baseline BMI in the association with knee or hip replacement.

Conclusions

In people with or at risk of clinically significant knee osteoarthritis, every 1% weight loss was associated with a 2% reduced risk of knee replacement and – in those people who also had one or more persistently painful hips – a 3% reduced risk of hip replacement, regardless of baseline BMI. Public health strategies that incorporate weight loss interventions have the potential to reduce the burden of knee and hip replacement surgery.

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Fig. 1: Selection of participants and knees and hips from the OAI data set for analyses.
Fig. 2: Histogram of body weight changes from baseline, as a percent of baseline body weight, that knees and hips were exposed to.
Fig. 3: Survival plots for knees and hips showing the probability of avoiding replacement over time.

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References

  1. Hunter DJ, Schofield D, Callander E. The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol. 2014;10:437–41.

    Article  PubMed  Google Scholar 

  2. Leifer VP, Katz JN, Losina E. The burden of OA-health services and economics. Osteoarthr Cartil. 2021. https://doi.org/10.1016/j.joca.2021.05.007.

  3. Daigle ME, Weinstein AM, Katz JN, Losina E. The cost-effectiveness of total joint arthroplasty: a systematic review of published literature. Best Pract Res Clin Rheumatol. 2012;26:649–58.

    Article  PubMed  Google Scholar 

  4. Kamaruzaman H, Kinghorn P, Oppong R. Cost-effectiveness of surgical interventions for the management of osteoarthritis: a systematic review of the literature. BMC Musculoskeletal Disord. 2017;18:183.

    Article  Google Scholar 

  5. Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA. 2021;325:568–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster J-Y. Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Joint Surg. 2004;86:963–74.

    Article  PubMed  Google Scholar 

  7. Welfare AIoHa. Health-care expenditure on arthritis and other musculoskeletal conditions 2008–09. Arthritis series no. 20. Cat. no. PHE 177. Canberra: AIHW; 2014.

  8. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393:1745–59.

    Article  CAS  PubMed  Google Scholar 

  9. Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, et al. Knee replacement. Lancet. 2018;392:1672–82.

    Article  PubMed  Google Scholar 

  10. Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet. 2018;392:1662–71.

    Article  PubMed  Google Scholar 

  11. Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393:655–63.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393:647–54.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sadoghi P, Liebensteiner M, Agreiter M, Leithner A, Böhler N, Labek G. Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplast. 2013;28:1329–32.

    Article  Google Scholar 

  14. Klouche S, Sariali E, Mamoudy P. Total hip arthroplasty revision due to infection: a cost analysis approach. Orthop Traumatol Surg Res. 2010;96:124–32.

    Article  CAS  PubMed  Google Scholar 

  15. Ackerman IN, Bohensky MA, Zomer E, Tacey M, Gorelik A, Brand CA, et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskeletal Disord. 2019;20:90.

    Article  Google Scholar 

  16. Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons - a scoping review. Obes Rev. 2014;15:578–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. George J, Klika AK, Navale SM, Newman JM, Barsoum WK, Higuera CA. Obesity epidemic: is its impact on total joint arthroplasty underestimated? An analysis of national trends. Clin Orthop Relat Res. 2017;475:1798–806.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ogden CLCM, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011–2. NCHS data brief, no 131. Hyattsville, MD: National Center for Health Statistics; 2013.

  19. Royal Australian College of General Practitioners (RACGP). Guideline for the management of knee and hip osteoarthritis. https://www.racgp.org.au/clinical-resources/clinical-guidelines/guidelines-by-topic/view-all-guidelines-by-topic/musculoskeletal-health/knee-and-hip-osteoporosis 2018.

  20. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2020;72:149–62.

    Article  Google Scholar 

  21. Fernandes L, Hagen KB, Bijlsma JWJ, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72:1125–35.

    Article  PubMed  Google Scholar 

  22. Jevsevar DS, Brown GA, Jones DL, Matzkin EG, Manner PA, Mooar P, et al. The American Academy of Orthopaedic Surgeons evidence-based guideline on: treatment of osteoarthritis of the knee, 2nd edition. J Bone Joint Surg. 2013;95:1885–6.

    Article  PubMed  Google Scholar 

  23. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22:363–88.

    Article  CAS  Google Scholar 

  24. Brosseau L, Wells GA, Tugwell P, Egan M, Dubouloz C-J, Casimiro L, et al. Ottawa panel evidence-based clinical practice guidelines for the management of osteoarthritis in adults who are obese or overweight. Phys Therapy. 2011;91:843–61.

    Article  Google Scholar 

  25. Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007;66:433–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310:1263–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hall M, Castelein B, Wittoek R, Calders P, Van Ginckel A. Diet-induced weight loss alone or combined with exercise in overweight or obese people with knee osteoarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2019;48:765–77.

    Article  PubMed  Google Scholar 

  28. Paans N, van den Akker-Scheek I, Dilling RG, Bos M, van der Meer K, Bulstra SK, et al. Effect of exercise and weight loss in people who have hip osteoarthritis and are overweight or obese: a prospective cohort study. Phys Therapy. 2013;93:137–46.

    Article  Google Scholar 

  29. Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Chanchek N, Guimaraes JB, et al. Is weight loss associated with less progression of changes in knee articular cartilage among obese and overweight patients as assessed with MR imaging over 48 months? Data from the osteoarthritis initiative. Radiology. 2017;284:508–20.

    Article  PubMed  Google Scholar 

  30. Anandacoomarasamy A, Leibman S, Smith G, Caterson I, Giuffre B, Fransen M, et al. Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage. Ann Rheum Dis. 2012;71:26–32.

    Article  CAS  PubMed  Google Scholar 

  31. Jafarzadeh SR, Clancy M, Li J-S, Apovian CM, Guermazi A, Eckstein F, et al. Changes in the structural features of osteoarthritis in a year of weight loss. Osteoarthr Cartil. 2018;26:775–82.

    Article  CAS  Google Scholar 

  32. Hunter DJ, Beavers DP, Eckstein F, Guermazi A, Loeser RF, Nicklas BJ, et al. The Intensive Diet and Exercise for Arthritis (IDEA) trial: 18-month radiographic and MRI outcomes. Osteoarthr Cartil. 2015;23:1090–8.

    Article  CAS  Google Scholar 

  33. Jin X, Gibson AA, Gale J, Schneuer F, Ding D, March L, et al. Does weight loss reduce the incidence of total knee and hip replacement for osteoarthritis?-A prospective cohort study among middle-aged and older adults with overweight or obesity. Int J Obes. 2021;45:1696–704.

    Article  Google Scholar 

  34. Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthr Cartil. 2015;23:507–15.

    Article  CAS  Google Scholar 

  35. Chaganti RK, Lane NE. Risk factors for incident osteoarthritis of the hip and knee. Curr Rev Musculoskelet Med. 2011;4:99–104.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Osteoarthritis Initiative (OAI) Study Protocol https://nda.nih.gov/oai/study-details.

  37. Lin DY. Cox regression analysis of multivariate failure time data: the marginal approach. Stat Med. 1994;13:2233–47.

    Article  CAS  PubMed  Google Scholar 

  38. Lui M, Jones CA, Westby MD. Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review. Syst Rev. 2015;4:121.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Chapter 4. Measurement error and bias. In: Epidemiology for the uninitiated: The British Medical Journal. https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated/4-measurement-error-and-bias.

  40. Newson RB. Attributable and unattributable risks and fractions and other scenario comparisons. Stata Journal. 2013;13:672–98.

    Article  Google Scholar 

  41. Mansournia MA, Altman DG. Population attributable fraction. BMJ. 2018;360:k757.

    Article  PubMed  Google Scholar 

  42. Authority TIHP. National Hospital Cost Data Collection Report: Public Sector, Round 23 Financial Year 2018-19. 2021. Available from https://www.ihpa.gov.au/publications/national-hospital-cost-data-collection-report-public-sector-round-23-financial-year.

  43. Registry AOANJR. Hip, Knee & Shoulder Arthroplasty Annual Report 2020. https://aoanjrr.sahmri.com/annual-reports-2020 2020.

  44. Registry AOANJR. Demographics of Hip, Knee & Shoulder Arthroplasty Annual Report 2020. https://aoanjrr.sahmri.com/annual-reports-2020/supplementary 2020.

  45. Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72:1125–35.

    Article  PubMed  Google Scholar 

  46. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22:363–88.

    Article  CAS  Google Scholar 

  47. Nevill AM, Metsios GS. The need to redefine age- and gender-specific overweight and obese body mass index cutoff points. Nutrition Diabetes. 2015;5:e186–e186.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Ensrud KE, Ewing SK, Stone KL, Cauley JA, Bowman PJ, Cummings SR. Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc. 2003;51:1740–7.

    Article  PubMed  Google Scholar 

  49. Langlois JA, Visser M, Davidovic LS, Maggi S, Li G, Harris TB. Hip fracture risk in older white men is associated with change in body weight from age 50 years to old age. Arch Internal Med. 1998;158:990.

    Article  CAS  Google Scholar 

  50. Newman AB, Yanez D, Harris T, Duxbury A, Enright PL, Fried LP, et al. Weight change in old age and its association with mortality. J Am Geriatr Soc. 2001;49:1309–18.

    Article  CAS  PubMed  Google Scholar 

  51. Prado CM, Purcell SA, Alish C, Pereira SL, Deutz NE, Heyland DK, et al. Implications of low muscle mass across the continuum of care: a narrative review. Ann Med. 2018;50:675–93.

    Article  PubMed  Google Scholar 

  52. Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, et al. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. Brit Med J. 2017;359:j4849.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Lean MEJ, Leslie WS, Barnes AC, Brosnahan N, Thom G, Mccombie L, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7:344–55.

    Article  PubMed  Google Scholar 

  54. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Data used in the preparation of this manuscript were obtained from the controlled access datasets distributed from the Osteoarthritis Initiative (OAI), a data repository housed within the National Institute of Mental Health (NIMH) Data Archive (NDA). OAI is a collaborative informatics system created by the NIMH and the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) to provide a worldwide resource to quicken the pace of biomarker identification, scientific investigation and osteoarthritis drug development. Dataset identifier(s): [NIMH Data Archive Digital Object Identifier (https://doi.org/10.15154/1521098)].

Funding

ZS is the recipient of an Australian Government Research Training Program Scholarship. This work was additionally supported by the National Health and Medical Research Council of Australia via a Senior Research Fellowship 1135897 to AS and an Early Career Research Fellowship 1143022 to XJ.

Author information

Authors and Affiliations

  1. The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia

    Zubeyir Salis, Blanca Gallego & Xingzhong Jin

  2. The University of Western Australia, School of Human Sciences, Crawley, WA, Australia

    Amanda Sainsbury

  3. The University of Western Australia, Medical School, Crawley, WA, Australia

    Helen I. Keen

  4. The University of Sydney, Institute of Bone and Joint Research, Kolling Institute, St Leonard, NSW, Australia

    Xingzhong Jin

  5. The University of Sydney, The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Camperdown, NSW, Australia

    Xingzhong Jin

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Contributions

Conception and design: ZS, AS, XJ. Acquisition, analysis and interpretation of data: ZS, AS, XJ. Critical review of the results: ZS, AS, HK, BG, XJ. Critical review of the manuscript: ZS, AS, BG, XJ. Statistical analysis: ZS. Drafting the paper: ZS, AS, XJ.

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Correspondence to Zubeyir Salis.

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Competing interests

ZS and AS own 50% each of the shares in Zuman International, which receives royalties for books AS has written and payments for presentations. AS additionally reports receiving presentation fees and travel reimbursements from Eli Lilly and Co, the Pharmacy Guild of Australia, Novo Nordisk, the Dietitians Association of Australia, Shoalhaven Family Medical Centres, the Pharmaceutical Society of Australia, and Metagenics, and serving on the Nestlé Health Science Optifast VLCD advisory board from 2016 to 2018.

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Salis, Z., Sainsbury, A., I. Keen, H. et al. Weight loss is associated with reduced risk of knee and hip replacement: a survival analysis using Osteoarthritis Initiative data. Int J Obes 46, 874–884 (2022). https://doi.org/10.1038/s41366-021-01046-3

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