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Is osteoarthritis of the knee related to occupation?

Osteoarthritis (OA) of the knee is one of the most frequent and functionally impairing disorders of the musculoskeletal system.

There are several risk factors for osteoarthritis of the knee. Body mass index (a high BMI precedes knee OA) is a high risk factor for both males and females. Occupation is another risk factor that has been linked to OA. Studies have varied in their design, in both definition of OA and exposure to workload.

The prevalence of knee OA is rising and the search for interventions to mitigate risk is intensifying. To investigate occupational physical activity as a cause of knee OA, a systematic search was undertaken in Medline and Embase covering the period 1996 to November 2011. The report contributed quantitative estimates of risk for knee OA (or knee joint surgery) in relation to one or more of six pre-specified activities (squatting, kneeling, climbing, lifting, standing, physical workload), or according to a comparison of job titles. Obese workers with such exposures are at additional risk of knee OA.

The study concluded that “knee OA is an increasingly common cause of morbidity and work limitation in later life. Occupational activities that physically load the joint – notably, squatting and kneeling for substantial parts of the working day, regular heavy lifting, climbing, and high physical workload – are likely to contribute to disease occurrence and/or progression and to symptom aggravation. Where possible these exposures should be minimized at source by job design. In any event, workers who are overweight and who have these elements in their daily work should be strongly encouraged to lose weight.”

Several studies have suggested that risk for osteoarthritis is increased by work which entails prolonged bending of the knees. Recent research has shown that there is moderate evidence for a relationship between kneeling and heavy lifting and knee OA. The majority of published studies have dealt either with hip or knee OA, relatively few studies have included both in the same cohort, thus enabling comparison of the risk for hip and knee OA. Most studies have been cross-sectional, but recently results from longitudinal studies have been published, strengthening the causality of occupation as a risk factor for knee and hip OA.

Factors that increase risk of osteoarthritis include:

Certain occupations: If your job includes tasks that place repetitive stress on a particular joint, that may predispose that joint toward eventually developing osteoarthritis.

Sedentary lifestyle: Cartilage depends on joint use for its nutrition.

Bone deformities: Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.

Joint injuries: Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.

Obesity: Carrying more body weight places more stress on your weight-bearing joints, such as your knees.

Other diseases: Having diabetes, underactive thyroid, gout or Paget’s disease of bone can increase your risk of developing osteoarthritis.

Older age: The risk of osteoarthritis increases with age.

Sex: Women are more likely to develop osteoarthritis, though it isn’t clear why.


Muraki S, Akune T, Oka H, Mabuchi A, En-Yo Y, Yoshida M, Saika A, Nakamura K, Kawaguchi H, Yoshimura N. Association of occupational activity with radiographic knee osteoarthritis and lumbar spondylosis in elderly patients of population-based cohorts: A large-scale population-based study. Arthritis & Rheumatism. 2009;61:779–86. PubMed.

Vingård E, Alfredsson L, Goldie I, Hogstedt C. Occupation and osteoarthrosis of the hip ad knee: A register-based cohort study. Int J Epidemiol. 1991;20:1025–31. PubMed.

Coggon D, Croft P, Kellingray S, Barrett D, McLaren M, Cooper C. Occupational physical activities and osteoarthritis of the knee. Arthritis & Rheumatism. 2000;43:1443–9. PubMed.

Dawson J, Juszczak E, Thorogood M, Marks S-A, Dodd C, Fitzpatrick R. An investigation of risk factors for symptomatic osteoarthritis of knee in women using a life course approach. J Epidemiol Community Health. 2003;57:823–30. PubMed.

Franklin J, Ingvarsson T, Englund M, Lohmander S. Association between occupation and knee and hip replacement due to osteoarthritis: a case-control study. Arthritis Research & therapy. 2010;12:R102. PubMed.




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