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The authors used data from the United States first national Health and Nutrition Examination Survey of 1971-1975 (HANES I) to explore the cross-sectional associations between radiographic osteoarthritis of the knee and a variety of putative risk factors. A total of 5,193 black and white study participants aged 35-74 years, 315 of whom had x-ray-diagnosed osteoarthritis of the knee, were available for analysis. After controlling for confounders, the authors found significant associations of knee osteoarthritis with overweight, race, and occupation, all of which have been suggested by smaller cross-sectional studies. They then focused specifically on those factors. For overweight, they found a strong association between current obesity and osteoarthritis of the knee, with a dose-response effect not previously assessed. This association was also seen for self-reported minimum adult weight, a proxy for long-term obesity, and was present in persons with asymptomatic osteoarthritis of the knee. These findings strongly suggest that obesity is causative. HANES I was the first study in which racial differences in osteoarthritis of the knee could be assessed within the same country. The black women who were studied had an increased risk of disease (odds ratio (OR) = 2.12, 95% confidence interval (CI) = 1.39-3.23) after controlling for age and weight, although the black men did not. Finally, the authors used the US Department of Labor Dictionary of Occupational Titles to obtain characterizations of the physical demands and knee-bending stress associated with occupations and to study the relation between physical demands of jobs and osteoarthritis of the knee. They found for persons aged 55-64 years an association between knee-bending demands and osteoarthritis of the knee (men, OR = 2.45, 95% CI = 1.21-4.97; women, OR = 3.49, 95% CI = 1.22-10.52). Since such occupational physical demands are common, the authors conclude that they may be associated with a substantial proportion of osteoarthritis of the knee.
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PMID:Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. 338 25

Knee osteoarthritis (OA) is a common cause of pain and long-term disability in the elderly, and the incidence among middle-aged adults is considerable. Well-recognized risk factors associated with knee OA include age, women, being overweight or obese, major knee injury, and occupational overuse of the knee. Although loss of articular cartilage represents the pathological hallmark of knee OA, changes in subchondral bone and soft tissue are major features. Because knee OA is chronic and progressive, it is paramount that patients and health care professionals work together to manage symptoms, and to prevent and minimize deleterious consequences. Patient education, exercise, weight reduction, thermal modalities, assistive devices, medications, and neutraceuticals are important components of therapy. This article reviews common nonpharmacological and pharmacological therapies essential for the effective management of knee OA.
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PMID:Knee osteoarthritis management therapies. 1170 59

The aim of this study was to describe the effect of sex, growth, Tanner stage, and physical activity on knee articular cartilage volume development. A total of 74 randomly selected male and female children aged 9-18 y were measured on two occasions at an average interval of 1.6 y (range 1.3-1.9). Articular cartilage volume was determined at the patella, medial tibial, and lateral tibial compartments by processing images acquired in the sagittal plane using T1-weighted fat saturation magnetic resonance. Height, weight, and BMI were measured while Tanner stage and physical activity were assessed by questionnaire. Articular cartilage volume increased at all sites peaking in Tanner stage two. Males gained articular cartilage faster than females at all sites (patella +233 microL/y, 95% CI -7, +473, medial tibial +350 microL/y, 95% CI +118, +582, lateral tibial +256 microL/y, 95% CI +22, +488). In both sexes, articular cartilage volume accrual at tibial but not patella sites correlated significantly with height change but not weight change. Overweight children did not differ significantly from normal children in articular cartilage volume either cross-sectionally or longitudinally. The most consistent physical activity association was with average intensity of sport with those above the median gaining approximately twice as much as those below the median at tibial (p < 0.05) but not patella sites. In conclusion, most children gain articular cartilage during growth, but there is wide variation in the amount of articular cartilage accrual. In particular, younger children, males, and those undertaking more vigorous sports have substantially higher accrual rates. These results provide novel data on articular cartilage development in humans. The long-term significance of these results with regard to osteoarthritis of the knee in later life remains hypothetical.
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PMID:Knee articular cartilage development in children: a longitudinal study of the effect of sex, growth, body composition, and physical activity. 1273 91

The development of arthrosis is best understood paradigmatically as the result of an interaction between individual and systemic risk factors. This review of the current literature on the subject identifies overweight, occupational exposure to repeated daily lifting and the postmenopausal decline in gonadal steroids in women as significant risk factors for the development of symptomatic and radiologic osteoarthritis of the knee.
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PMID:[Risk factors for osteoarthritis of the knee: current status]. 1622 90

Epidemiological studies show an increased prevalence of osteoarthritis of the knee and hand with increased body mass index [BMI]. Osteoarthritis of the hip joint is not related to BMI. The connection between obesity and osteoarthritis cannot exclusively be explained by genetic factors or by the accumulation of tear and wear. Overweight occurs prior to knee joint degeneration, not as a result of diminished activity due to joint degeneration. Weight control seems to be an influential tool in the prophylaxis of overweight-specific joint degeneration.
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PMID:[Osteoarthritis and obesity]. 1640 48

Depression is common in overweight and obese individuals with chronic illness. The purpose of this study was to determine the relationship between depression and functional status. Baseline data were used from 105 overweight/obese participants who enrolled in a clinical trial for overweight and obese adults with osteoarthritis of the knee. Forty-two percent of the sample was classified as depressed according to the Center for Epidemiologic Studies Depression Scale. A moderate relationship was seen between perceived physical function and physical performance in patients who were not depressed that did not exist in patients reporting depressive symptoms. In a stepwise regression analysis, poorer function (as measured by the Western Ontario and MacMaster Universities (Osteoarthritis Index) function subscale) and younger age accounted for 29 percent of the variance in depressive symptoms.
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PMID:Relationship between depression and functional measures in overweight and obese persons with osteoarthritis of the knee. 2043 15

Presently, there are multiple nonoperative techniques a surgeon can use to alleviate the pain of an osteoarthritic joint including: oral medications, physical therapy, injections and off-loading knee braces. The objective of this study was to analyze subjects under in vivo, dynamic conditions using fluoroscopy to determine if off-loading knee braces actually separate the femoral condyle from the tibial plateau during the mid-stance and heel-strike phases of gait. Forty subjects with substantial unicompartmental osteoarthritis were studied under fluoroscopic surveillance in the frontal plane while performing normal gait on a treadmill. The subjects were patients of one surgeon and were all clinically diagnosed to have marked unicompartimental degenerative joint space narrowing. Initially, each subject was asked to perform normal gait on a treadmill under fluoroscopic surveillance in the frontal plane. An offloading osteoarthritic knee brace was then fixated on the osteoarthritic knee joint. The subjects were then asked to walk on level ground while wearing the brace to rate the effectiveness of the brace in alleviating pain. The subjects were then asked to perform normal gait on a treadmill while wearing the brace. Successive fluoroscopic images of each patient at mid-stance and heel-strike (with and without a brace) were downloaded to a workstation computer. The captured fluoroscopic images were then analyzed using digitization. Thirty-four of forty subjects (85%) judged the osteoarthritic knee brace effective in reducing knee pain. Six of the subjects (15%) were not able to detect a change in knee pain. All of these subjects were overweight resulting in suboptimal brace fixation. Thirty-one of forty subjects (78%) demonstrated articular separation of the degenerative knee compartment at heel-strike and 28/40 (70%) at midstance. Thirty-one of forty subjects (78%) experienced an angular change at heel-strike, while 37/40 experienced an angular change at mid-stance. The average amount of change in condylar separation (A) was 1.7 mm (0.0-6.4) at heel-strike and 1.9 mm (0.0-7.9) at mid-stance. The average amount of change in angle ?S was 2.0 degrees (0.0-4.8 degrees) at heel-strike and 1.6 degrees (0.0-5.1) at mid-stance. Previous biomechanical studies have documented excessive loads in degenerative compartments of patients with unicompartmental arthrosis and associated angular deformities. Offloading braces have been developed to attempt to lessen loads in the degenerative compartment with subsequent reductions in knee pain. This present study demonstrates in vivo articular separation of degenerative knee compartments can be achieved with offloading braces with subsequent subjective relief of knee pain. These braces may have limited effectiveness in obese patients. Key words: osteoarthritis of the knee, a knee brace, conservative treatment.
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PMID:An in vivo analysis of the effectiveness of the osteoarthritic knee brace during heel strike and midstance of gait. 2047 72

"Exercise is medicine": exercise therapy reduces pain and activity limitations in osteoarthritis of the knee and is likely to have the same effects in osteoarthritis of the hip. Further research into exercise therapy is needed, since disease-modifying drugs are not available, pain medication can cause side effects, and surgical interventions are preferably applied in an advanced stage of disease. Classical exercise therapy is aimed at improving muscle strength, aerobic capacity, range of joint motion, and training of walking and activities of daily living. New modalities of targeted exercise therapy are currently being developed, aimed at the correction of low levels of activity and to correct instability of the knee. Weight loss, preferably combined with exercise therapy, reduces pain and activity limitations in osteoarthritis patients who are overweight. Modalities of exercise therapy adapted to comorbid conditions are currently being developed.
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PMID:[Exercise therapy in hip or knee osteoarthritis]. 2208 10

Knee osteoarthritis (OA) is a leading cause of functional disability among American adults. Obesity is a strong independent risk factor for OA. While research emphasizes the role of obesity in the OA-physical function relationship, the extent to which weight status impacts salient physical, health, and pain measures in older, knee OA patients is not well delineated. The primary aim of this study was to assess differences in mobility performance (stair climb and 400-meter walk), mobility-related self-efficacy, pain symptoms (WOMAC), and measures of accelerometer-determined physical activity (PA) as a function of weight status. Analysis of covariance was conducted to examine differences on the dependent variables. Obese class III patients were outperformed by their counterparts on nearly every measure of mobility, mobility-related self-efficacy, and the assessment of pain symptoms. These outcomes did not differ among other weight comparisons. Normal weight subjects outperformed classes I, II, and III counterparts on most measures of PA (engagement in moderate or greater PA and total weekly steps). Additionally, overweight participants outperformed obese class II participants and obese class I participants outperformed obese classes II and III participants on total weekly steps. Collectively, these findings underscore the meaningful differences observed in relevant OA outcomes as a function of increasing levels of body weight.
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PMID:Weight status and differences in mobility performance, pain symptoms, and physical activity in older, knee osteoarthritis patients. 2496 1

Knee osteoarthritis (OA) affects approximately 1 in 10 adults in the United States, with higher prevalence in women, aggravated by increased weight. This quasi-experimental pilot study implemented an online self-management (SM) program for older overweight and obese women with knee OA combined with a two-arm progressive exercise trial (walking and stepping groups). After the 10-week intervention using an interprofessional approach, activation to SM scores were significantly higher in all participants (N = 16) and between groups, with a higher increase in the stepping group. Those with higher activation scores pre-intervention obtained higher scores post-intervention. Activation levels also increased significantly among all participants with majority at the highest activation level. Follow-up data at 6 weeks and 6 months showed sustained SM and health-directed behaviors. These findings, although preliminary, highlight the value of combined SM and progressive exercise intervention using an interprofessional approach. Further investigations are essential toward potential practice and policy changes.
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PMID:Activation to self-management and exercise in overweight and obese older women with knee osteoarthritis. 2507 45


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