Weight gain and the risk of knee replacement due to primary osteoarthritis

Apold, H.; Meyer, Haakon E; Nordsletten, Lars; Furnes, Ove; Baste, Valborg; Flugsrud, Gunnar B

doi:10.1016/j.joca.2014.03.002

Cited by 47 publications

(17 citation statements)

References 26 publications

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“…Similar results have been found in studies investigating BMI, where weight gain in early adulthood (between age 20–40 at screening) was associated with increased risk of both THR and TKR [ 37 , 38 ]. The cumulative effect of excess bodyweight over several decades compared to those who gain weight later in life was proposed as one possible explanation for the increased risk of OA and later joint replacement [ 39 ].…”

Section: Discussionsupporting

confidence: 85%

Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study)

Johnsen

Hellevik

Baste

et al. 2016

BMC Musculoskelet Disord

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BackgroundThe relationship between leisure time physical activity (LPA) and hip and knee OA and subsequent joint replacement has not yet been clearly defined. Some studies have found the risk of knee replacement (TKR) to increase with high levels of LPA, while others have found no overall relationship to either TKR or hip replacement (THR). The aim was to investigate the association between LPA and the risk of severe end-stage OA, defined as THR or TKR due to primary OA, in a large population-based cohort.MethodsParticipants in the Nord-Trøndelag Health Study (HUNT) were followed prospectively to identify THR and TKR using the Norwegian Arthroplasty Register. Self-reported LPA was classified as inactive, low, moderate or high. The Cox proportional hazards model was used to calculate hazard ratios (HRs) according to levels of LPA with adjustments for confounding variables. Analyses were performed by age (<45, 45–59 and ≥60 years) and sex.ResultsA total of 66 964 participants (mean age 46.8 years (SD 16.3) were included in the analyses. We identified 1636 THRs and 1016 TKRs due to primary OA during 17.0 years (median) of follow-up. High LPA was significantly associated with THR for women <45 years (HR 1.78, 95 % CI 1.08–2.94) and men between 45–59 years (HR 1.53, 95 % CI 1.10–2.13) at baseline. A significant trend was found only among women < 45 years at baseline (p = 0.02). We found that LPA was significantly associated with TKR for women only (HR 1.45, 95 % CI 1.03–2.04). No measures of LPA were associated with TKR for men.ConclusionIn this population-based study, high level of LPA was associated with increased risk of THR where a significant trend of LPA was seen among women <45 years at baseline. For TKR, high LPA was associated with increased risk only in women. In contrast to previous studies, this study shows a possible association between high LPA and the risk of THR.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0937-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 85%

Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study)

Johnsen

Hellevik

Baste

et al. 2016

BMC Musculoskelet Disord

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“…Obesity is also a growing burden in many countries and, as this has been shown to be a certain risk factor for knee osteoarthritis, especially in young patients, it may contribute to the increasing demand for TKAs in future (Apold et al. 2014a, b, Silverwood et al. 2015).…”

Section: Discussionmentioning

confidence: 99%

Different incidences of knee arthroplasty in the Nordic countries

et al. 2017

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Background and purposeThe annual number of total knee arthroplasties (TKAs) has increased worldwide in recent years. To make projections regarding future needs for primaries and revisions, additional knowledge is important. We analyzed and compared the incidences among 4 Nordic countriesPatients and methodsUsing Nordic Arthroplasty Register Association (NARA) data from 4 countries, we analyzed differences between age and sex groups. We included patients over 30 years of age who were operated with TKA or unicompartmental knee arthroplasty (UKA) during the period 1997–2012. The negative binomial regression model was used to analyze changes in general trends and in sex and age groups.ResultsThe average annual increase in the incidence of TKA was statistically significant in all countries. The incidence of TKA was higher in women than in men in all 4 countries. It was highest in Finland in patients aged 65 years or more. At the end of the study period in 2012, Finland’s total incidence was double that of Norway, 1.3 times that of Sweden and 1.4 times that of Denmark. The incidence was lowest in the youngest age groups (< 65 years) in all 4 countries. The proportional increase in incidence was highest in patients who were younger than 65 years.InterpretationThe incidence of knee arthroplasty steadily increased in the 4 countries over the study period. The differences between the countries were considerable, with the highest incidence in Finland. Patients aged 65 years or more contributed to most of the total incidence of knee arthroplasty.

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“…The indication of an increased risk of TKR among former smokers (women) might be more attributed to the indirect effect through BMI, as the direct effect of former smoking was non-significant. This corresponds to the fact that former smokers tend to gain weight compared to current smokers [ 19 ], and increased body weight is an established risk factor for TKR [ 16 , 17 ]. This corroborates with the findings from a population-based cohort of 63 257 Chinese men and women, where the inverse association between smoking and risk of TKR was quickly attenuated with increasing duration of smoking cessation [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, a possible explanation for the inverse association is smoking’s connection with other lifestyle factors that may affect the risk-relationship with OA. Increased weight or body mass index (BMI) is an established risk factor for OA and subsequent joint replacement [ 6 , 16 , 17 ]. If smoking is associated with low BMI, as corroborated in Mendelian randomization studies [ 18 , 19 ], then part of the protective effect of smoking may be due to BMI.…”

Section: Introductionmentioning

confidence: 99%

The mediating effect of body mass index on the relationship between smoking and hip or knee replacement due to primary osteoarthritis. A population-based cohort study (the HUNT Study)

et al. 2017

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To investigate the total effect of smoking on total hip or knee replacement (THR/TKR) due to primary osteoarthritis (OA) and to quantify the indirect effect of smoking through body mass index (BMI). Participants from the Nord-Trøndelag Health Study (the HUNT Study) were linked to the Norwegian Arthroplasty Register to detect the first THR or TKR due to primary OA. A mediation analysis was used to decompose the total effect of smoking into a direct and indirect effect. BMI was considered a mediator in the analysis. All effects were estimated as hazard ratios (HRs) with 95% confidence intervals (CIs). The indirect effect of smoking mediated through BMI was expressed as a percentage (proportion*100). In total 55 188 participants were followed up during 17.2 years (median). We identified 1322 THRs and 754 TKRs. For men, the total effect of current vs. never smoking revealed a decreased risk of THR (HR 0.59, 95% CI 0.46–0.76) and TKR (HR 0.47, 95% CI 0.32–0.66). For women, current smoking increased the risk of THR (HR 1.34, 95% CI 1.11–1.60). For men, 6% and 7% of the risk reduction for THR and TKR, respectively, was mediated by BMI. We found a negative association between smoking and THR or TKR for men. On the contrary, smoking was associated with increased risk of THR for women. Most of the effect of smoking on joint replacement risk remained unexplained by BMI.

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Weight gain and the risk of knee replacement due to primary osteoarthritis

Cited by 47 publications

References 26 publications

Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study)

Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study)

Different incidences of knee arthroplasty in the Nordic countries

The mediating effect of body mass index on the relationship between smoking and hip or knee replacement due to primary osteoarthritis. A population-based cohort study (the HUNT Study)

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