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

Abstract

Purpose: To perform a systematic review with best evidence synthesis examining the literature on the relationship between occupational loading tasks and knee osteoarthritis (OA). Methods: Two databases were searched to identify articles published between 1946 and April, 2011. Eligible studies were those that (1) included adults reporting on their employment history; (2) measured individuals' exposure to work-related activities with heavy loading in the knee joint; and (3) identified presence of knee OA (determined by X-ray), cartilage defects associated with knee OA (identified by magnetic resonance imaging), or joint replacement surgery. Results: A total of 32 articles from 31 studies met the inclusion criteria. We found moderate evidence that combined heavy lifting and kneeling is a risk factor for knee OA, with odds ratios (OR) varying from 1.8 to 7.9, and limited evidence for heavy lifting (OR=1.4–7.3), kneeling (OR=1.5–6.9), stair climbing (OR=1.6–5.1), and occupational groups (OR=1.4–4.7) as risk factors. When examined by sex, moderate level evidence of knee OA was found in men; however, the evidence in women was limited. Conclusions: Further high-quality prospective studies are warranted to provide further evidence on the role of occupational loading tasks in knee OA, particularly in women.