University of New South Wales Centre for Big Data Research in Health, Kensington, New South Wales, Australia.
The University of Western Australia, Crawley, Western Australia, Australia.
Arthritis Care Res (Hoboken). 2023 Jun;75(6):1340-1350. doi: 10.1002/acr.25021. Epub 2023 Jan 5.
To define the association between change in body mass index (BMI) and the risk of knee and hip replacement.
We used data from 3 independent cohort studies: the Osteoarthritis Initiative (OAI), the Multicenter Osteoarthritis Study (MOST), and the Cohort Hip and Cohort Knee (CHECK) study, which collected data from adults (45-79 years of age) with or at risk of clinically significant knee osteoarthritis. We conducted Cox proportional hazards regression analysis with clustering of both knees and hips per person to determine the association between change in BMI (our exposure of interest) and the incidence of primary knee and hip replacement over 7-10 years' follow-up. Change in BMI (in kg/m ) was calculated between baseline and the last follow-up visit before knee or hip replacement, or for knees and hips that were not replaced, the last follow-up visit.
A total of 16,362 knees from 8,181 participants, and 16,406 hips from 8,203 participants, were eligible for inclusion in our knee and hip analyses, respectively. Change in BMI was positively associated with the risk of knee replacement (adjusted hazard ratio [HR ] 1.03 [95% confidence interval (95% CI) 1.00-1.06]) but not hip replacement (HR 1.00 [95% CI 0.95-1.04]). The association between change in BMI and knee replacement was independent of participants' BMI category at baseline (i.e., normal, overweight, or obese).
Public health strategies incorporating weight loss interventions could reduce the burden of knee but not hip replacement surgery.
定义体重指数（BMI）变化与膝关节和髋关节置换风险之间的关联。
我们使用了三个独立队列研究的数据：骨关节炎倡议（OAI）、多中心骨关节炎研究（MOST）和队列髋部和队列膝关节（CHECK）研究，这些研究从有或有临床显著膝关节骨关节炎风险的成年人（45-79 岁）中收集数据。我们对每个人的双膝和双髋进行了 Cox 比例风险回归分析，以确定 BMI 变化（我们感兴趣的暴露因素）与 7-10 年随访期间原发性膝关节和髋关节置换的发生率之间的关联。BMI 的变化（kg/m ）是在基线和膝关节或髋关节置换前的最后一次随访之间计算的，或者对于未置换的膝关节和髋关节，是在最后一次随访时计算的。
共有 16362 个膝关节和 8181 名参与者，16406 个髋关节和 8203 名参与者符合我们的膝关节和髋关节分析条件。BMI 的变化与膝关节置换的风险呈正相关（调整后的危险比[HR]1.03[95%置信区间（95%CI）1.00-1.06]），但与髋关节置换无关（HR 1.00[95%CI 0.95-1.04]）。BMI 变化与膝关节置换之间的关联独立于参与者基线时的 BMI 类别（即正常、超重或肥胖）。
纳入减肥干预措施的公共卫生策略可以减少膝关节置换手术的负担，但不能减少髋关节置换手术的负担。
