Effects of a Three-Month Low Calorie Diet Weight Loss Intervention on Knee Replacement Outcomes

Study Overview
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Brief Summary
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Total Knee Replacement (TKR) significantly improves function, pain, and overall quality of life in patients with end-stage arthritis of the knee. However, studies show that obesity increases complications and costs associated with TKR. The American Academy of Orthopaedic Surgeons (AAOS) clinical guidelines recommend that patients with a BMI > 25kg/m2 lose 5% of their body weight prior to surgery. Consequently, although it is not clear how to patients or providers achieve weight loss in this population, some providers and hospitals decline to perform TKR in patients with obesity. Low Calorie meal replacement diets (LCD) are a feasible way to safely promote short-term weight loss of 8-15% at 3-6 months prior to some elective surgeries. This is a pilot efficacy study to test whether a short-term program using a 3-month LCD leads to weight loss and improved patient reported and functional outcomes. 75 patients eligible for knee replacement surgery and willing to undergo non-operative weight management treatment at NYU Langone Comprehensive Obesity Center. This study will establish feasibility and weight loss outcomes in preparation for a multicenter effectiveness trial.

Official Title
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A Pilot Study Investigating the Effects of a Three-Month Low Calorie Diet Weight Loss Intervention on Knee Replacement Outcomes

Conditions
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Obesity

Intervention / Treatment
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* Combination Product: LCD Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: BMI 35-45 kg/m2 Any ethnicity Able to speak, read, and write in English Have knee replacement surgery already planned by the surgeon Plan to undergo knee replacement surgery within 3-6 months post LCD intervention Willing to commute to NYU Langone Weight Management Clinic at the start of the dietary intervention, midway through, and end of intervention Exclusion Criteria: Uncontrolled type 2 diabetes, defined as HbA1c > 9% If smokes cigarettes, must go through a 6 week cessation program first Type 1 diabetes Whey protein allergies Soy allergies Anyone in whom rapid weight loss is not indicated (e.g., ESRD or cirrhosis, metabolic cancer, abnormal 3 times UL liver enzyme labs) Current untreated or uncontrolled eating disorder (e.g., binge eating, bulimia) Rheumatoid arthritis In case a previous knee replacement surgery was done, the participant should wait at least 1 year from previous date of surgery Undergoing simultaneous bilateral knee replacement Enrolled in a formal weight loss program Taking anti-obesity medications Coexisting psychotic conditions requiring hospitalization or more intense treatment (e.g., bipolar mood disorder, severe depression) Abnormal CBC, and uric acid, must be treated prior to start of intervention Higher than 5.5 mU/L or lower than 0.3 mU/L TSH must be treated prior to start of LCD intervention

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Low Calorie Diet (LCD) diet intervention<br>In person or video conference | Combination Product: LCD Intervention<br>* composed of approximately 1,080 kcal/day, which includes 3 New Direction Meal Replacements containing 200 kcal (27g protein, 12g carbhydrate, 2g fiber), 1 protein bar containing 160 kcal (5 g protein, 18g carbohydrate, 5g fiber, 2g sugar alcohol), and a 350-calorie controlled meal of protein and vegetables that the patient will make on his/ her own.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in weight | Patients who have had recent knee replacement will be weighed at screening, week 5-7, week 11-13, and 30-120 days post surgery | up to 18 Months | 
| Change in mobility during 30-sec chair stand |  | 18 Months | 
| Change in mobility during 40-meter fast paced walk |  | 18 Months | 
| Change in quality of life measured by SF-36 questionnaire | The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. To calculate the scores it is necessary to purchase special software. Pricing depends on the number of scores that the researcher needs to calculate. The eight sections are: vitality physical functioning bodily pain general health perceptions physical role functioning emotional role functioning social role functioning mental health | 18 Months |