C.C. Norman and T.A. Kress (USA)
knee, osteoarthritis, risk factors, epidemiology,prevention, ergonomics
Cited risk factors in epidemiological studies for knee osteoarthritis (OA) were investigated. A search of articles published in scientific journals was conducted using PubMed, ScienceDirect, InterScience, and The University of Tennessee (U.S.A.) Library E-Journals, using key words including "joint disease," "osteoarthritis," "knee," "gonarthrosis," "arthrosis," "arthritis," "risk factors," and "epidemiology." Inclusion criteria narrowed the field of articles for the focus of most of the discussion in this paper. Assessed risk factors, such as age, gender, obesity, weight loss, occupational, physical activity, genetic, hormone, bone characteristics, and their association with OA are summarized. Conclusions and recommendations are presented, some of which include: 1) Three clear OA risk factors are age, high BMI, and physical activity. When any of these three are present with other risk factors, generally OA risk is increased. However, it is interesting to note that physical activity seems to be a "necessary risk factor", in that literature indicates that patients with lower extremity paralysis (wheelchair confined) do not develop knee OA. 2) Significant risk reduction could be obtained if high BMI and heavy physical activity were uncoupled. 3) Ergonomic job design should address minimizing knee bending (including kneeling and squatting) unnecessarily. 4) Industry should promulgate the use of appropriately padded floor surfaces and knee pads as required personal protective equipment for certain exposures. Shoe selection is also important, especially for exposures such as jogging or running. 5) Individuals experiencing occupational or non-occupational physical activity involving excessive pronation of the foot/lower leg or individuals with pre-existing varus knees are particularly vulnerable to development of OA. 6) Certain systemic factors also put individuals at increased risk for development of knee OA. 7) Individuals involved in certain manual labor jobs, such as floor-layers, construction workers, forestry workers, and farmers, are at risk for development of knee OA prematurely. 8) Work environment training should focus on awareness education with respect to the risk factors.
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