Body Mass Index- and Waist Circumference-Defined Obesity with the risk of Total Knee Arthroplasty for Osteoarthritis: A prospective cohort study
Abstract Background: There is a discordance in classification of obesity when defined by body mass index (BMI) or waist circumference (WC). We aimed to examine whether categories of BMI- and WC-defined obesity are differentially associated with the risk of total knee arthroplasty for osteoarthritis.Methods: 38,924 participants from the Melbourne Collaborative Cohort Study with BMI and WC measured at baseline (1990-1994) were included. Obesity status was defined as: not obese (non-obese BMI and non-obese WC); WC-defined obesity only (non-obese BMI and obese WC); BMI-defined obesity only (non-obese WC and obese BMI); and BMI- and WC-defined obesity. The incidence of total knee arthroplasty for osteoarthritis between January 2001 and December 2013 was determined by linking participant records to the National Joint Replacement Registry. Results: Over 11.5±3.1 years follow-up, 1,875 participants underwent total knee arthroplasty for osteoarthritis. Participants with WC-defined obesity only (HR=1.79, 95%CI 1.51-2.53), BMI-defined obesity only (HR=2.39, 95%CI 2.02-2.84), and BMI- and WC-defined obesity (HR=3.14, 95%CI 2.82-3.49) had an increased risk of total knee arthroplasty compared with those who were not obese. Conclusions: Individuals with either BMI- or WC-defined obesity should be targeted for prevention of knee osteoarthritis as both are significant predictors for severe osteoarthritis requiring a total knee arthroplasty.