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(1) To estimate the life-time genetic contribution for knee osteoarthritis (OA) surgery and (2) to explore any differences in the genetic contribution across age, sex and body mass index (BMI).

We studied the sex-specific genetic contribution to knee OA surgery in a prospective cohort study of 62,490 twins aged 35 years or older with a follow-up period of up to 47 years (10,092 identical and 21,153 non-identical twin pairs, 54% women). To study interactions with age, we graphed the heritabilities over the lifespan for men and women. We also studied the sex-specific heritability across strata of the median BMI to explore any interactions with BMI.

The overall heritability of knee OA surgery was 0.53 (95% confidence intervals [CI] = 0.31–0.75), with higher heritability among women (H² = 0.80 (95% CI = 0.73–0.87)) than men (H² = 0.39 (95% CI = 0.10–0.69)). For men, the heritability started to rise …