Risk factors for knee replacement due to primary osteoarthritis, a population based, prospective cohort study of 315,495 individuals

BMC Musculoskeletal Disorders

Gunnar B Flugsrud³  Valborg Baste²  Ove Furnes⁶  Lars Nordsletten⁴  Haakon E Meyer⁵  Hilde Apold¹ 

[1] Orthopaedic department, Telemark Hospital, Skien, Norway;The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;Orthopaedic department, Oslo University Hospital, Oslo, Norway;Faculty of medicine, University of Oslo, Oslo, Norway;Norwegian Institute of Public Health, Division of Epidemiolgy, Oslo, Norway;Department of Surgical Sciences, Faculty of Medicine and Dentistry, Bergen, Norway

关键词: Epidemiology;    Risk factor;    Body mass index;    Knee joint replacement;    Obesity;    Osteoarthritis;   

Others  :  1125513
DOI  :  10.1186/1471-2474-15-217

 received in 2013-09-03, accepted in 2014-06-10,  发布年份 2014

【 摘 要 】

Background

Osteoarthritis (OA) of the knee is a common and disabling condition. We wanted to investigate the modifiable risk factors Body Mass Index (BMI) and physical activity, using knee replacement (KR) as a marker for severely symptomatic disease, focusing on the interaction between these risk factors.

Methods

315,495 participants (mean age 43.0 years) from national health screenings were followed prospectively with respect to KR identified by linkage to the Norwegian Arthroplasty Register. Data were analysed by Cox proportional hazard regression.

Results

During 12 years of follow up 1,323 individuals received KR for primary OA. There was a dose–response relationship between BMI and heavy labour, and later KR. Comparing the highest versus the lowest quarter of BMI, the relative risk was 6.2 (95% CI: 4.2-9.0) in men and 11.1 (95% CI: 7.8-15.6) in women. Men reporting intensive physical activity at work had a relative risk of 2.4 (95% CI: 1.8-3.2) versus men reporting sedentary activity at work, the corresponding figure in women being 2.3 (95% CI: 1.7-3.2). The effect of BMI and physical activity at work was additive. The heaviest men with the most strenuous work had a RR of 11.7 (95% CI: 5.9-23.1) compared to the ones with the lowest BMI and most sedentary work. For women the corresponding RR was 15.8 (95% CI: 8.2-30.3). There was no association between physical activity during leisure and KR.

Conclusion

We found that a high BMI and intensive physical activity at work both contribute strongly to the risk of having a KR. As the two risk factors seem to act independently, people with strenuous physical work with a high BMI are at particularly high risk for severely disabling OA of the knee, and should be targeted with effective preventive measures.

【 授权许可】

   
2014 Apold et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Spector TD, Cicuttini F, Baker J, Loughlin J, Hart D: Genetic influences on osteoarthritis in women: a twin study. BMJ 1996, 312:940-943.
• [2]Leyland KM, Hart DJ, Javaid MK, Judge A, Kiran A, Soni A, Goulston LM, Cooper C, Spector TD, Arden NK: The natural history of radiographic knee osteoarthritis: a fourteen-year population-based cohort study. Arthritis Rheum 2012, 64:2243-2251.
• [3]Li Y, Wei X, Zhou J, Wei L: The age-related changes in cartilage and osteoarthritis. [Review]. BioMed Res Int 2013. article ID 916530. http://dx.doi.org/10.1155/2013/916530 webcite
• [4]Felson DT, Nevitt MC, Zhang Y, Aliabadi P, Baumer B, Gale D, Li W, Yu W, Xu L: High prevalence of lateral knee osteoarthritis in Beijing Chinese compared with Framingham Caucasian subjects. Arthritis Rheum 2002, 46:1217-1222.
• [5]Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G: A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis Cartilage 2005, 13(9):769-781.
• [6]Toivanen AT, Heliovaara M, Impivaara O, Arokoski JP, Knekt P, Lauren H, Kroger H: Obesity, physically demanding work and traumatic knee injury are major risk factors for knee osteoarthritis–a population-based study with a follow-up of 22 years. Rheumatology (Oxford) 2010, 49:308-314.
• [7]Muthuri SG, McWilliams DF, Doherty M, Zhang W: History of knee injuries and knee osteoarthritis: a meta-analysis of observational studies. [Review]. Osteoarthritis Cartilage 2011, 19(11):1286-1293.
• [8]Martin KR, Kuh D, Harris TB, Guralnik JM, Coggon D, Wills AK: Body mass index, occupational activity, and leisure-time physical activity: an exploration of risk factors and modifiers for knee osteoarthritis in the 1946 British birth cohort. BMC Musculoskelet Disord 2013, 14:219.
• [9]Vingard E, Alfredsson L, Goldie I, Hogstedt C: Occupation and osteoarthrosis of the hip and knee: a register-based cohort study. Int J Epidemiol 1991, 20:1025-1031.
• [10]Felson DT, Hannan MT, Naimark A, Berkeley J, Gordon G, Wilson PW, Anderson J: Occupational physical demands, knee bending, and knee osteoarthritis: results from the Framingham Study. J Rheumatol 1991, 18:1587-1592.
• [11]Jarvholm B, From C, Lewold S, Malchau H, Vingard E: Incidence of surgically treated osteoarthritis in the hip and knee in male construction workers. Occup Environ Med 2008, 65:275-278.
• [12]Spector TD, Harris PA, Hart DJ, Cicuttini FM, Nandra D, Etherington J, Wolman RL, Doyle DV: Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls. Arthritis Rheum 1996, 39(6):988-995.
• [13]Ageberg E, Engstrom G, de Verdier Gerhardsson M, Rollof J, Roos E, Lohmander L: Effect of leisure time physical activity on severe knee or hip osteoarthritis leading to total joint replacement: a population-based prospective cohort study. BMC Musculoskelet Disord 2012, 13:73.
• [14]Wang Y, Simpson JA, Wluka AE, Teichtahl AJ, English DR, Giles GG, Graves S, Cicuttini FM: Is physical activity a risk factor for primary knee or hip replacement due to osteoarthritis? A prospective cohort study. J Rheumatol 2011, 38:350-357.
• [15]Racunica TL, Teichtahl AJ, Wang Y, Wluka AE, English DR, Giles GG, O'Sullivan R, Cicuttini FM: Effect of physical activity on articular knee joint structures in community-based adults. Arthritis Rheum 2007, 57(7):1261-1268.
• [16]Vignon E, Valat JP, Rossignol M, Avouac B, Rozenberg S, Thoumie P, Avouac J, Nordin M, Hilliquin P: Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS). [Review] [103 refs]. Joint Bone Spine 2006, 73(4):442-455.
• [17]Mork PJ, Holtermann A, Nilsen TI: Effect of body mass index and physical exercise on risk of knee and hip osteoarthritis: longitudinal data from the Norwegian HUNT Study. J Epidemiol Community Health 2012, 66:678-683.
• [18]Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M, Pols HA, Bierma-Zeinstra SM: Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 2007, 56:1204-1211.
• [19]Felson DT, Niu J, Gross KD, Englund M, Sharma L, Cooke TD, Guermazi A, Roemer FW, Segal N, Goggins JM, Lewis CE, Eaton C, Nevitt MC: Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative. Arthritis Rheum 2013, 65(2):355-362.
• [20]Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman B, Aliabadi P, Levy D: Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. Arthritis Rheum 1997, 40:728-733.
• [21]Mnatzaganian G, Ryan P, Reid CM, Davidson DC, Hiller JE: Smoking and primary total hip or knee replacement due to osteoarthritis in 54,288 elderly men and women. BMC Musculoskelet Disord 2013, 14:262.
• [22]Wilder FV, Hall BJ, Barrett JP: Smoking and osteoarthritis: is there an association? The Clearwater Osteoarthritis Study. Osteoarthritis Cartilage 2013, 11(1):29-35.
• [23]Hart DJ, Spector TD: Cigarette smoking and risk of osteoarthritis in women in the general population: the Chingford study. Ann Rheum Dis 1993, 52(2):93-96.
• [24]Hui M, Doherty M, Zhang W: Does smoking protect against osteoarthritis? Meta-analysis of observational studies. [Review]. Ann Rheum Dis 2011, 70(7):1231-1237.
• [25]Blagojevic M, Jinks C, Jeffery A, Jordan KP: Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. [Review] [101 refs]. Osteoarthritis Cartilage 2010, 18:24-33.
• [26]Pearce F, Hui M, Ding C, Doherty M, Zhang W: Does smoking reduce the progression of osteoarthritis? Meta-analysis of observational studies. Arthritis Care Res 2013, 65(7):1026-1033.
• [27]Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF: Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med 1988, 109:18-24.
• [28]Lohmander LS, de Verdier Gerhardsson M, Rollof J, Nilsson PM, Engstr+Âm G: Incidence of severe knee and hip osteoarthritis in relation to different measures of body mass: a population-based prospective cohort study. Ann Rheum Dis 2009, 68:490-496.
• [29]Hart DJ, Doyle DV, Spector TD: Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study. Arthritis Rheum 1999, 42:17-24.
• [30]Jarvholm B, Lewold S, Malchau H, Vingard E: Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men. Eur J Epidemiol 2005, 20:537-542.
• [31]Holmberg S, Thelin A, Thelin N: Knee osteoarthritis and body mass index: a population-based case–control study. Scand J Rheumatol 2005, 34:59-64.
• [32]Mnatzaganian G, Ryan P, Norman PE, Davidson DC, Hiller JE: Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population-based cohort of men. Arthritis Rheum 2011, 63:2523-2530.
• [33]McWilliams DF, Leeb BF, Muthuri SG, Doherty M, Zhang W: Occupational risk factors for osteoarthritis of the knee: a meta-analysis. [Review]. Osteoarthritis Cartilage 2011, 19:829-839.
• [34]Jensen LK: Knee osteoarthritis: influence of work involving heavy lifting, kneeling, climbing stairs or ladders, or kneeling/squatting combined with heavy lifting. [Review] [45 refs]. Occup Environ Med 2008, 65(2):72-89.
• [35]Hannan MT, Felson DT, Anderson JJ, Naimark A: Habitual physical activity is not associated with knee osteoarthritis: the Framingham Study. J Rheumatol 1993, 20(4):704-709.
• [36]Felson DT, Niu J, Clancy M, Sack B, Aliabadi P, Zhang Y: Effect of recreational physical activities on the development of knee osteoarthritis in older adults of different weights: the Framingham Study. Arthritis Rheum 2007, 57:6-12.
• [37]Hannan MT, Felson DT, Pincus T: Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol 1994, 27(6):1513-1517.
• [38]Nawaz H, Chan W, Abdulrahman M, Larson D, Katz DL: Self-reported weight and height: implications for obesity research. Am J Prev Med 2001, 20(4):294-298.
• [39]Coggon D, Croft P, Kellingray S, Barrett D, McLaren M, Cooper C: Occupational physical activities and osteoarthritis of the knee. Arthritis Rheum 2000, 43:1443-1449.
• [40]Vrezas I, Elsner G, Bolm-Audorff U, Abolmaali N, Seidler A: Case–control study of knee osteoarthritis and lifestyle factors considering their interaction with physical workload. Int Arch Occup Environ Health 2010, 83:291-300.
• [41]Tverdal A, Bjartveit K: Health consequences of reduced daily cigarette consumption. Tob Control 2006, 15:472-480.
• [42]Tverdal A, Hjellvik V, Selmer R: Heart rate and mortality from cardiovascular causes: a 12 year follow-up study of 379,843 men and women aged 40–45 years. Eur Heart J 2008, 29:2772-2781.
• [43]Lochen ML, Rasmussen K: The Tromso study: physical fitness, self reported physical activity, and their relationship to other coronary risk factors. J Epidemiol Community Health 1992, 46:103-107.
• [44]Furnes O, Espehaug B, Lie SA, Vollset SE, Engesaeter LB, Havelin LI: Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994–2000. Acta Orthop Scand 2002, 73:117-129.
• [45]Tverdal A, Stensvold I, Solvoll K, Foss OP, Lund-Larsen P, Bjartveit K: Coffee consumption and death from coronary heart disease in middle aged Norwegian men and women. BMJ 1990, 300:566-569.
• [46]Thelle DS, Foorde OH, Try K, Lehmann EH: The Tromsoo heart study. Methods and main results of the cross-sectional study. Acta Med Scand 1976, 200:107-118.
• [47]Saltin B, Grimby G: Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation 1968, 38:1104-1115.
• [48]Stender M, Hense HW, Doring A, Keil U: Physical activity at work and cardiovascular disease risk: results from the MONICA Augsburg study. Int J Epidemiol 1993, 22:644-650.
• [49]Wilhelmsen L, Tibblin G, Aurell M, Bjure J, Ekstrom-Jodal B, Grimby G: Physical activity, physical fitness and risk of myocardial infarction. Adv Cardiol 1976, 18:217-230.
• [50]Stender M, Doring A, Hense HW, Schlichtherle S, M’Harzi S, Keil U: Comparison of 2 methods for the assessment of physical activity]. [German]. Soz Praventivmed 1991, 36:176-183.
• [51]Levin ML: The occurrence of lung cancer in man. Acta Unio Internationalis Contra Cancrum 1953, 9(3):531-541.
• [52]The Norwegian Arthroplasty Register Report 2013 2013. http://nrlweb.ihelse.net webcite
• [53]Robertsson O, Bizjajeva S, Fenstad AM, Furnes O, Lidgren L, Mehnert F, Odgaard A, Pedersen AB, Havelin LI: Knee arthroplasty in Denmark, Norway and Sweden. Acta Orthop 2010, 81:82-89.
• [54]Changulani M, Kalairajah Y, Peel T, Field RE: The relationship between obesity and the age at which hip and knee replacement is undertaken. J Bone Joint Surg (Br) 2008, 90-B:360-363.
• [55]Gandhi R, Wasserstein D, Razak F, Davey JR, Mahomed NN: BMI independently predicts younger age at hip and knee replacement. Obesity (Silver Spring) 2010, 18:2362-2366.
• [56]Oliveria SA, Felson DT, Reed JI, Cirillo PA, Walker AM: Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum 1995, 38:1134-1141.
• [57]Espehaug B, Furnes O, Havelin LI, Engesæter LB, Vollset SE, Kindseth O: Registration completeness in the Norwegian Arthroplasty Register. Acta Orthop 2006, 77:49-56.
• [58]Cooper C, Snow S, McAlindon TE, Kellingray S, Stuart B, Coggon D, Dieppe PA: Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum 2000, 43:995-1000.
• [59]Liu B, Balkwill A, Banks E, Cooper C, Green J, Beral V, on behalf of the Million Women Study Collaborators: Relationship of height, weight and body mass index to the risk of hip and knee replacements in middle-aged women. Rheumatology (Oxford) 2007, 46:861-867.
• [60]Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M: Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res 2007, 465:185-188.
• [61]Wendelboe AM, Hegmann KT, Biggs JJ, Cox CM, Portmann AJ, Gildea JH, Gren LH, Lyon JL: Relationships between body mass indices and surgical replacements of knee and hip joints. Am J Prev Med 2003, 25:290-295.
• [62]Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C: Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord 2001, 25:622-627.
• [63]Cooper C, McAlindon T, Coggon D, Egger P, Dieppe P: Occupational activity and osteoarthritis of the knee. Ann Rheum Dis 1994, 53:90-93.
• [64]Allen KD, Chen JC, Callahan LF, Golightly YM, Helmick CG, Renner JB, Jordan JM: Associations of occupational tasks with knee and hip osteoarthritis: the Johnston County Osteoarthritis Project. J Rheumatol 2010, 37:842-850.
• [65]Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ: Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med 2000, 133:321-328.
• [66]Tveit M, Rosengren BE, Nilsson JA, Karlsson MK: Former male elite athletes have a higher prevalence of osteoarthritis and arthroplasty in the hip and knee than expected. Am J Sports Med 2012, 40:527-533.
• [67]Michaelsson K, Byberg L, Ahlbom A, Melhus H, Farahmand BY: Risk of severe knee and hip osteoarthritis in relation to level of physical exercise: a prospective cohort study of long-distance skiers in Sweden. PLoS ONE [Electronic Resource] 2011, 6(3):e18339.
• [68]Eastmond CJ, Hudson A, Wright V: A radiological survey of the hips and knees in female specialist teachers of physical education. Scand J Rheumatol 1979, 8:264-268.
• [69]Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Engeland A, Meyer HE: The impact of body mass index on later total hip arthroplasty for primary osteoarthritis. Arthritis Rheum 2006, 54:802-807.