Longitudinal Associations Between Baseline Sarcopenia and Knee Osteoarthritis Progression and Risk of Knee Replacement

Objectives Sarcopenia and knee osteoarthritis (KOA) are common conditions in older adults, but the relationship is controversial. We aimed to examine the potential role of sarcopenia in KOA progression and subsequent knee replacement (KR). Methods Using data from the Osteoarthritis Initiative (OAI), baseline sarcopenia was first screened according to the EWGSOP2 algorithm using the SARC‐F questionnaire (screened sarcopenia, Scre‐S), then further assessed combined with the five times chair‐stand‐test (probable sarcopenia, Prob‐S). Radiographic KOA progression was evaluated by changes in Kellgren‐Lawrence Grade (KLG) and Osteoarthritis Research Society International (OARSI) atlas scores from baseline to 24‐ and 48‐month follow‐up. Symptomatic progression was evaluated similarly using the Western Ontario McMaster Osteoarthritis Index (WOMAC). The associations of sarcopenia with radiographic or symptomatic progression and subsequent KR were analyzed before and after adjusting for potential confounders and propensity score (PS)‐matching. Results 4316 participants were included with 27.2% being Scre‐S and 16.8% being Prob‐S. Baseline Scre‐S and Prob‐S were positively associated with both radiographic and symptomatic progression in KOA, over 24 and 48 months. Both Scre‐S and Prob‐S were associated with a higher risk of subsequent KR (HR 3.84, 95% CI 3.18 to 4.62 for Scre‐S and HR 2.29, 95% CI 1.87 to 2.81 for Prob‐S). These results remained significant in the PS‐matched cohort. Conclusions Scre‐S and Prob‐S were significantly and longitudinally associated with both radiographic and symptomatic progression in KOA and subsequent KR. Our findings indicated a potential causal role of sarcopenia in KOA progression, and highlighted its potentially therapeutic effect in KOA management. image