Occupational Exposure to Knee Loading and the Risk of Osteoarthritis of the Knee: A Systematic Review and a Dose-Response Meta-Analysis

Abstract

BackgroundOsteoarthritis of the knee is considered to be related to knee straining activities at work. The objective of this review is to assess the exposure dose-response relation between kneeling or squatting, lifting, and climbing stairs at work, and knee osteoarthritis.MethodsWe included cohort and case–control studies. For each study that reported enough data, we calculated the odds ratio (OR) per 5,000 hours of cumulative kneeling and per 100,000 kg of cumulative lifting. We pooled these incremental ORs in a random effects meta-analysis.ResultsWe included 15 studies (2 cohort and 13 case–control studies) of which nine assessed risks in more than two exposure categories. We considered all but one study at high risk of bias. The incremental OR per 5,000 hours of kneeling was 1.26 (95% confidence interval 1.17–1.35, 5 studies, moderate quality evidence) for a log-linear exposure dose-response model. For lifting, there was no exposure dose-response per 100,000 kg of lifetime lifting (OR 1.00, 95% confidence interval 1.00–1.01). For climbing, an exposure dose-response could not be calculated.ConclusionThere is moderate quality evidence that longer cumulative exposure to kneeling or squatting at work leads to a higher risk of osteoarthritis of the knee. For other exposure, there was no exposure dose-response or there were insufficient data to establish this. More reliable exposure measurements would increase the quality of the evidence.

Men and Women's Occupational Activities and the Risk of Developing Osteoarthritis of the Knee, Hip, or Hands: A Systematic Review and Recommendations for Future Research

“…Yet there was no effect when squatting and kneeling were examined individually. This diversity in findings has been noted previously , and it highlights the need for attention to measurement, including whether compartmentalizing or differentiating among knee bending tasks accurately reflects real‐world work conditions in the frequency and duration of knee bending, and whether knee bending occurs in conjunction with lifting heavy loads . Some jurisdictions are trying to address these issues and have identified minimum thresholds for frequency and duration of kneeling related to work compensation claims , but in the absence of detailed evidence, thresholds are set high.…”

“…One domain of importance for education and intervention is the workplace. To date, numerous studies have examined the relationship of physically demanding occupations like farming, mining, and floor laying, as well as work activities like kneeling, squatting, and heavy lifting to the onset of OA .

A synthesis of 69 studies from 23 countries yielded strong and moderate evidence for lifting, cumulative physical loads, full‐body vibration, and kneeling/squatting/bending as increasing the risks of developing osteoarthritis (OA) in men and women. Strong and moderate evidence existed for no increased risk of OA related to sitting, standing and walking (hip and knee OA), lifting and carrying (knee OA), climbing ladders (knee OA), driving (knee OA), and highly repetitive tasks (hand OA). Greater attention is needed to improve measures assessing employment activities and recall periods. A lack of consistency in dose‐response information makes synthesizing data problematic and hinders practical recommendations.

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“…One domain of importance for education and intervention is the workplace. To date, numerous studies have examined the relationship of physically demanding occupations like farming, mining, and floor laying, as well as work activities like kneeling, squatting, and heavy lifting to the onset of OA (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Occupational risk factors for musculoskeletal disorders among railroad maintenance‐of‐way workers

“…MOW workers perform such movements routinely during the installation of tracks and ballast 13 . Occupational ergonomic risk factors for osteoarthritis of the hip and knee have also become the focus of a recent WHO/ILO study initiative to assess the national and global burden of work‐related injuries 12,37 . Heavy rail construction vehicles require the use of foot pedals (such as for the throttle and brakes) to control the function of the vehicle.…”

“…In 1997, in a major review of the epidemiological evidence, National Institute for Occupational Safety and Health (NIOSH) concluded that a consistent relationship exists between MSDs and certain biomechanical risk factors, including heavy physical work, lifting and forceful movements, bending and twisting (nonneutral postures), static work postures, and WBV 8 . Since then, additional studies have shown that WBV is associated with neck disorders, 9,10 and repetitive kneeling in certain trades (ie, floor installer, roofer, and material handler) is causing occupational knee disorders 11,12 . In Germany, knee arthrosis in certain occupations was added in 2009 to the recognized list of occupational diseases no.…”