An investigation of risk factors for symptomatic osteoarthritis of the knee in women using a life course approach

Abstract

Study objective: To explore risk factors for symptomatic knee osteoarthritis (OAK) in women, which included wearing high heeled shoes. Design: Matched case-control study. Exposure information obtained by interview, included details about past footwear. Self reported weight and height data obtained representing when women left school, were aged 36-40 and were aged 51-55. Regular work activities (including periods when homemaker or carer), smoking, and hormone related data gathered using a life-grid. Setting: Interviews in participants' homes. Cases identified from orthopaedic hospital surgical waiting list, controls identified by general practitioners (GPs) Participants: Women aged 50 to 70 years. Cases awaiting knee replacement surgery. Controls, who had no past knee surgery and no knee pain in the past three years, were matched for age and GP. Altogether 111 eligible women were interviewed (29 cases, 82 controls). Main results: Univariate analyses identified several significant associations with OAK including past knee injury, arthritis of the feet, heavy smoking, being overweight (BMI 25 or above) and various occupational activities. Virtually all measures of high heeled shoes use were associated with reduced risk of OAK, although none of these findings were statistically significant. In multivariate analysis only BMI 25 or above at age 36-40 remained significantly associated with OAK (OR 36.4, 95% CI 3.07 to 432, p = 0.004), although weak evidence suggested certain occupational activities might increase risk. Weight gain in early adult life was particularly pronounced among cases. Conclusions: Being overweight before the age of 40 considerably increased the risk of subsequent symptomatic OAK in women. Wearing high heeled shoes did not.A round 2.4% of people over 55 years are disabled by knee pain due to symptomatic osteoarthritis of the knee (OAK).1 The prevalence of OAK increases with age, with a greater increase in women. By the age of 65 years, around twice as many women as men are affected. This gender difference suggests that women either carry a higher risk of OAK in itself, or that they experience greater exposure to risk factors.

Occupational Physical Loading Tasks and Knee Osteoarthritis: A Review of the Evidence

“…19,39,41,43 Of these 16 articles, 11 showed a significant positive association between kneeling/knee bending and knee OA with substantial ORs between 1.5 and 6.9. 11,13,14,19,24,25,27,29,30,36,43 Nine papers received a quality score >11, 9,13,14,19,25,29,39,41,43 four of them published after 2004. Six of these articles reported statistically significant results, yet neither of the two cohort studies, 9,22 one of which was high quality, found statistically significant results.…”

“…These include two cohort studies, 9,22 nine case-control studies that produced 10 articles, 11,13,14,24,25,27,29,30,32,36 and four cross-sectional studies. 19,39,41,43 Of these 16 articles, 11 showed a significant positive association between kneeling/knee bending and knee OA with substantial ORs between 1.5 and 6.9.…”

“…The study design included three cohort studies, 9,21,22 12 case-control publications from 11 studies, 11,13,14,20,[24][25][26][29][30][31][32]36 and three cross-sectional studies. 19,38,41 Of these, 11 articles 11,13,14,19,21,26,[29][30][31]36,38 showed a significantly positive association between heavy lifting and knee OA, with odds ratios (ORs) between 1.4 and 7.3.…”

“…The study design included three cohort studies, 9,21,22 12 case-control publications from 11 studies, 11,13,14,20,[24][25][26][29][30][31][32]36 and three cross-sectional studies. 19,38,41 Of these, 11 articles 11,13,14,19,21,26,[29][30][31]36,38 showed a significantly positive association between heavy lifting and knee OA, with odds ratios (ORs) between 1.4 and 7.3. Ten studies 9,13,14,19,25,26,29,31,41 were deemed to be of high quality based on the Jensen criteria; four of these were published since the 2004 review, 14,31,41,46 and three reported a statistically significant positive result.…”

Relationship between the goniometric alignment and articular cartilage damage in knee osteoarthritis

“…The sample is thus representative of patients with primary osteoarthritis as it is reported predominantly in women aged 60 years and above [20,21]. Obesity is also a known risk factor as seen in our sample which had an average BMI of 27 [22].…”