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Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage
  1. A Anandacoomarasamy1,2,3,
  2. S Leibman3,4,
  3. G Smith3,4,
  4. I Caterson5,
  5. B Giuffre3,6,
  6. M Fransen7,
  7. P N Sambrook1,3,
  8. L March1,3
  1. 1Institute of Bone and Joint Research, Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
  2. 2Rheumatology, Concord Hospital, Sydney, Australia
  3. 3University of Sydney, Sydney, New South Wales, Australia
  4. 4Royal North Shore Hospital, Sydney, Department of Surgery, New South Wales, Australia
  5. 5Human Nutrition, University of Sydney, Sydney, New South Wales, Australia
  6. 6Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
  7. 7Clinical and Rehabilitation Sciences Research Group, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor L March, Department of Rheumatology, Royal North Shore Hospital, University of Sydney, Building 35, Level 4, St Leonards, Sydney, NSW 2065, Australia; lynmar{at}


Background Obesity is an important risk factor for knee osteoarthritis (OA), Weight loss can reduce the symptoms of knee OA. No prospective studies assessing the impact of weight loss on knee cartilage structure and composition have been performed.

Objectives To assess the impact of weight loss on knee cartilage thickness and composition.

Methods 111 obese adults were recruited from either laparoscopic adjustable gastric banding or exercise and diet weight loss programmes from two tertiary centres. MRI was performed at baseline and 12-month follow-up to assess cartilage thickness. 78 eligible subjects also underwent delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), an estimate of proteoglycan content. The associations between cartilage outcomes (cartilage thickness and dGEMRIC index) and weight loss were adjusted for age, gender, body mass index (BMI) and presence of clinical knee OA.

Results Mean age was 51.7±11.8 years and mean BMI was 36.6±5.8 kg/m2; 32% had clinical knee OA. Mean weight loss was 9.3±11.9%. Percentage weight loss was negatively associated with cartilage thickness loss in the medial femoral compartment in multiple regression analysis (β=0.006, r2=0.19, p=0.029). This association was not detected in the lateral compartment (r2=0.12, p=0.745). Percentage weight loss was associated with an increase in medial dGEMRIC in multiple regression analysis (β=3.9, r2=0.26; p=0.008) but not the lateral compartment (r2=0.14, p=0.34). For every 10% weight loss there was a gain in the medial dGEMRIC index of 39 ms (r2=0.28; p=0.014). The lowest weight loss cut-off associated with reduced medial femoral cartilage thickness loss and improved medial dGEMRIC index was 7%.

Conclusions Weight loss is associated with improvements in the quality (increased proteoglycan content) and quantity (reduced cartilage thickness losses) of medial articular cartilage. This was not observed in the lateral compartment. This could ultimately lead to a reduced need for total joint replacements and is thus a finding with important public health implications.

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  • Funding AA was supported by a National Health and Medical Research Council Medical Postgraduate Research Scholarship (402901).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Northern Sydney Central Coast Area Health Service Human Research Ethics Committee and University of Sydney and informed consent was obtained from all study participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Contributors All authors contributed to the manuscript.

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