Effects of hypothetical low- versus moderate- to high-intensity weight management regimens on knee replacements

This study aimed to investigate the efficacy of a hypothetical biennial weight management regimen in reducing the necessity for knee replacement (KR) surgery among middle-aged and older adults with or at a higher risk for knee osteoarthritis (OA). Data were used from the Osteoarthritis Initiative cohort in the United States, comprising community-dwelling adults aged 45 to 79 years at high risk for or with symptomatic knee OA who underwent baseline assessments from September 2008 to December 2010. Subsequent evaluations were conducted at 12, 24, and 96 months. A hypothetical biennial weight management regimen, ranging from low to moderate-to-high intensity, was employed as the exposure, whereas the incidence of KR during follow-up was the outcome. This study, using a targeted learning approach to estimate hypothetical weight management regimens adjusted for time-varying confounding and attrition due to loss to follow-up, revealed that a 7.5% reduction in body mass index (high intensity) resulted in a notable decrease in KR rates, from 5.93% (95% CI, 5.64-6.21) in the baseline maintenance regimen (low intensity) to 3.60% (95% CI, 2.70-4.50) in the high-intensity regimen. In conclusion, a hypothetical weight management regimen significantly reduces the need for KR surgery in adults with knee OA.