Habitual floor activities increase risk of knee osteoarthritis

The ability and factors related with floor sitting after total hip arthroplasty with a posterolateral approach

Background

Prosthesis dislocation following total hip arthroplasty (THA) is one complication that affects treatment outcome and increases the cost of treatment. Currently, many surgeons prohibit patients from performing floor-based activities; however, these prohibitions might affect the lifestyle of a number of patients.

Objective

This study aimed to evaluate the ability of floor sitting after THA, and factors associated with this ability.

Methods

This study was a retrospective cohort study, evaluating 240 patients who underwent THA with a posterolateral approach, in a single tertiary hospital. Patient demographic data, preoperative clinical data, prostheses type, and postoperative radiographic were extracted from the electronic medical records. Postoperative ability to perform floor sitting was evaluated at 6 months postoperatively.

Results

There were 52 patients (21.66%) who were able to sit on the floor postoperatively. Multivariate logistic regression analysis showed independent association between three factors with ability to sit on the floor after surgery: pre-operative external rotation range of motion (OR 1.03; 95% CI, 1.01-1.06; P = 0.01), pre-operative Harris Hip Scores (OR 1.05; 95% CI, 1.01-1.10; P = < 0.01), pre-operative ability to sit on the floor (OR 10.2; 95% CI, 3.65-28.5; P = < 0.01).

Conclusion

There were a number of patients who could sit on the floor after THA. However, there were factors which were associated with this ability. Hence, these results could be useful for adjusted patient preoperative expectations, and did not preclude all patients to perform floor activities.

Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies

BACKGROUND

Knee osteoarthritis (OA) is a major cause of disability in the elderly, however, there are few studies to estimate the global prevalence, incidence, and risk factors of knee OA.

METHODS

For this study, we searched PUBMED, EMBASE and SCOPUS from inception to April 4, 2020, without language restriction. We identified eligible studies with information on the prevalence or incidence of knee OA in population-based observational studies and extracted data from published reports. We did random-effects meta-analysis to generate estimates. This study was registered with PROSPERO (CRD42020181035).

FINDINGS

Out of 9570 records identified, 88 studies with 10,081,952 participants were eligible for this study. The pooled global prevalence of knee OA was 16⋅0% (95% CI, 14⋅3%-17⋅8%) in individuals aged 15 and over and was 22⋅9% (95% CI, 19⋅8%-26⋅1%) in individuals aged 40 and over. Correspondingly, there are around 654⋅1 (95% CI, 565⋅6-745⋅6) million individuals (40 years and older) with knee OA in 2020 worldwide. The pooled global incidence of knee OA was 203 per 10,000 person-years (95% CI, 106-331) in individuals aged 20 and over. Correspondingly, there are around annual 86⋅7 (95% CI, 45⋅3-141⋅3) million individuals (20 years and older) with incident knee OA in 2020 worldwide. The prevalence and incidence varied substantially between individual countries and increased with age. The ratios of prevalence and incidence in females and males were 1⋅69 (95% CI, 1⋅59-1⋅80, p<0⋅00) and 1⋅39 (95% CI, 1⋅24-1⋅56, p<0⋅00), respectively.

INTERPRETATION

Our study provides the global prevalence (16⋅0% [95% CI, 14⋅3%-17⋅8%]) and incidence (203 per 10,000 person-years [95% CI, 106-331]) of knee OA. These findings can be used to better assess the global health burden of knee OA. Further prospective cohort studies are warranted to identify modifiable risk factors for providing effectively preventive strategies in the early stages of the disease.

FUNDING

This work was supported by grants from the National Natural Science Foundation of China (nos. 81772384 and 81572174).

Association of frequent knee bending activity with focal knee lesions detected with 3T magnetic resonance imaging: data from the osteoarthritis initiative

OBJECTIVE

To evaluate the association of baseline frequent knee bending activities with the prevalence and progression of cartilage and meniscal abnormalities over 3 years and to assess the effect of frequent knee bending on the different knee compartments with 3T magnetic resonance imaging (MRI).

METHODS

We studied 115 subjects without radiographic knee osteoarthritis (OA) but with risk factors for OA from the Osteoarthritis Initiative database. The inclusion criteria at baseline were age 45-55 years, body mass index of 19-27 kg/m(2) , Western Ontario and McMaster Universities Osteoarthritis Index pain score of 0, and Kellgren/Lawrence grade <2. Knee bending activities (kneeling, squatting, stair climbing, and weight lifting) were assessed by questionnaire at the baseline clinic visit. Cartilage and meniscal abnormalities were graded using the Whole-Organ MRI Score. Logistic regression was used to determine the association of frequent knee bending with cartilage and meniscal abnormalities.

RESULTS

Frequent knee bending activities were associated with an increased risk of prevalent cartilage lesions (odds ratio [OR] 3.63, 95% confidence interval [95% CI] 1.39-9.52), in particular in the patellofemoral compartment (OR 3.09, 95% CI 1.22-7.79). The increase in risk was higher in subjects involved in ≥2 knee bending activities. At 3-year followup, individuals reporting frequent knee bending were more likely to show progression of cartilage damage (OR 4.12, 95% CI 1.27-13.36) and meniscal abnormalities (OR 4.34, 95% CI 1.16-16.32).

CONCLUSION

Frequent knee bending activities were associated with a higher prevalence of knee cartilage lesions (particularly in the patellofemoral compartment) and with an increased risk of progression of cartilage and meniscal lesions in asymptomatic middle-aged subjects.

Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review

STUDY DESIGN

Systematic review with meta-analysis.

OBJECTIVES

To identify risk factors for osteoarthritis (OA) of the knee, hip, and ankle, including joint injury, sport, physical activity, overweight/obesity, and occupational activity, in all age groups.

BACKGROUND

OA is a significant health problem worldwide, affecting up to 10% of men and 18% of women over 60 years of age. There has not been a comprehensive review examining modifiable physical risk factors associated with the onset of OA. This evidence is important to inform the physiotherapy management of individuals following onset of OA.

METHODS

Twelve electronic databases were systematically reviewed. The studies selected met the following criteria: (1) original data; (2) joint injury, sport activity, physical activity, overweight/obesity, and/or occupational activity investigated as risk factors; (3) outcomes included OA (hip, knee, and/or ankle); and (4) analytic component of study design. The data extracted included study design, years of follow-up, study population, OA definition, risk factors, and results (effect estimates reported or calculated where available). The quality of evidence was assessed based on a modified version of the Downs and Black checklist.

RESULTS

Joint injury, obesity, and occupational activity were associated with an increased risk of OA of the knee and hip. Sport and physical activity produced inconsistent findings. Joint injury was identified as a significant risk factor for knee OA (combined odds ratio = 3.8; 95% confidence interval: 2.0, 7.2) and hip OA (combined odds ratio = 5.0; 95% confidence interval: 1.4, 18.2), as was previous meniscectomy with or without anterior cruciate ligament injury for knee OA (combined odds ratio = 7.4; 95% confidence interval: 4.0, 13.7). There is a paucity of research examining risk factors associated with ankle OA; this review identified only 2 studies with this outcome.

CONCLUSION

Joint injury, obesity, and occupational activity are associated with an increased risk of knee and hip OA. Some findings remain inconclusive, including levels of physical activity and sport specificity in individuals who do not suffer an injury. Early identification of individuals at risk for OA provides an opportunity for physiotherapy management or other interventions to modify risk-related behavior. There is a need in the literature for additional high-quality studies, such as prospective cohort studies, that minimize potential bias in examining the relationship between physical risk factors and OA.

LEVEL OF EVIDENCE

Prognosis, level 2a-.

In rural Tibet, the prevalence of lower limb pain, especially knee pain, is high: an observational study

QUESTION

What is the point prevalence and 12-month prevalence of lower limb musculoskeletal pain in rural Tibet? Does this differ with gender or age? What factors that could contribute to lower limb musculoskeletal pain are commonly present?

DESIGN

Observational study using an investigator-administered questionnaire and observation walks through villages.

PARTICIPANTS

499 people aged 15 years and over living in 19 rural villages of Shigatse Municipality, Tibet.

RESULTS

The point prevalence of lower limb musculoskeletal pain was 40% (95% CI 34 to 46) while the 12-month prevalence was 48% (95% CI 42 to 54). In particular, the point prevalence of knee pain was 25% (95% CI 20 to 30) and the 12-month prevalence was 29% (95% CI 23 to 35), which was significantly higher than at any other site in the lower limb. On average, being female was not associated with lower limb musculoskeletal pain either currently (OR 1.3, 95% CI 0.9 to 1.9) or over the previous 12 months (OR 1.2, 95% CI 0.9 to 1.8), whereas being older than 50 years was, both for current pain (OR 4.1, 95% CI 2.8 to 6.1) and pain over the previous 12 months (OR 4.0, 95% CI 2.7 to 6.0). Observation walks through the villages revealed people squatting for sustained periods, carrying heavy loads for long distances, wearing poor quality footwear, and with severe bowing of the legs but no obesity.

CONCLUSION

Lower limb musculoskeletal pain, particularly knee pain, is common in this rural Tibetan population. They live an extremely arduous life that appears to place considerable pressure on their knees.

Occupational kneeling and radiographic tibiofemoral and patellofemoral osteoarthritis

BACKGROUND

The objective of our study was to evaluate the association between occupational kneeling and compartment specific radiographic tibiofemoral (TF) and patellofemoral (PF) osteoarthritis (OA).

METHODS

Questionnaire data and bilateral knee radiographs were obtained in 134 male floor layers and 120 male graphic designers (referents). Weight-bearing radiographs in three views (postero-anterior, lateral and axial) were classified according to joint space narrowing. After the exclusion of subjects with reports of earlier knee injuries the odds ratio (OR) with 95% confidence intervals (CI) of TF and PF OA was computed among floor layers compared to graphic designers in three age groups (</= 49; 50-59; >/= 60 years). Using logistic regression, estimates were adjusted for body mass index and knee-straining sports. In addition, the association between trade seniority and TF OA was assessed in age-adjusted test for trend analyses.

RESULTS

The prevalence of TF OA was significantly higher among floor layers aged 50-59 years compared to graphic designers (OR = 3.6, 95% CI = 1.1-12.0) while non-significant estimates were found in the young and elderly age groups. Furthermore, the adjusted OR of TF OA increased with trade seniority among floor layers (test for trend, OR = 2.2, 95% CI = 1.0-5.1), but not among graphic designers (OR = 1.2, 95% CI = 0.4-3.5). There were no significant differences regarding PF OA between the two occupational groups.

CONCLUSION

Results corroborate the existence of a causal relationship between occupational kneeling and radiographic TF OA and suggest a dose-response association with trade seniority. An association between kneeling and PF OA was however doubtful. Apparent discrepancies between findings in different age groups are most likely reflecting selection bias.

Patterns of knee osteoarthritis in Arabian and American knees

This study illustrates differences in the cartilage degeneration in osteoarthritic knees in patients with more frequent hyperflexion activities of daily living compared with Western patients. Proximal tibial articular cartilage wear and cruciate ligament condition were assessed in Saudi Arabian and North American patients with varus osteoarthritis undergoing total knee arthroplasty. In anterior cruciate ligament (ACL) intact knees, there were significant differences in wear location, with a clearly more anterior pattern in Saudi Arabian knees. Complete ACL deficiency occurred in 25% of North American knees but only 14% of Saudi Arabian knees. These ACL-deficient knees showed the most severe cartilage wear in both groups and posterior medial wear patterns. Biomechanical descriptions of knee flexion and axial rotation during kneeling or squatting are consistent with the more pronounced anteromedial and posterolateral cartilage wear patterns observed on the Saudi Arabian knees. These observations provide insight into altered knee mechanics in 2 culturally different populations with different demands on knee flexion.

Osteoarthritis

Osteoarthritis (OA) is a chronic degenerative disorder characterized by cartilage loss. Its prevalence is high, and it is a major cause of disability. The cause of OA is not known; however, current evidence indicates that it is multifactorial. Major risk factors for osteoarthritis are age, female sex, obesity, geographic factors, occupational knee-bending, physical labour, genetic factors and race, joint trauma, vitamin D deficiency, and chondrocalcinosis. Osteoarthritis causes joint pain, stiffness, and limitation of joint function. Knee involvement is the commonest presentation of this disease all over the world. Given the absence of a curative treatment, it is important to treat osteoarthritis as effectively as possible using a multidisciplinary approach tailored to the patient's needs. This article reviews current thinking on the epidemiology, clinical presentation, lifestyle, genetic epidemiology, and management of osteoarthritis in developing countries.