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 from the Osteoarthritis Initiative cohort in the US, comprising community-dwelling adults aged 45-79 years at high risk for or with symptomatic knee OA who underwent baseline assessments from September 2008 to December 2010 were used. 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% confidence interval (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.