Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2003 Oct;57(10):823–830. doi: 10.1136/jech.57.10.823

An investigation of risk factors for symptomatic osteoarthritis of the knee in women using a life course approach

J Dawson 1, E Juszczak 1, M Thorogood 1, S Marks 1, C Dodd 1, R Fitzpatrick 1
PMCID: PMC1732289  PMID: 14573590

Abstract

Study objective: To explore risk factors for symptomatic knee osteoarthritis (OAK) in women, which included wearing high heeled shoes.

Design: Matched case-control study. Exposure information obtained by interview, included details about past footwear. Self reported weight and height data obtained representing when women left school, were aged 36–40 and were aged 51–55. Regular work activities (including periods when homemaker or carer), smoking, and hormone related data gathered using a life-grid.

Setting: Interviews in participants' homes. Cases identified from orthopaedic hospital surgical waiting list, controls identified by general practitioners (GPs)

Participants: Women aged 50 to 70 years. Cases awaiting knee replacement surgery. Controls, who had no past knee surgery and no knee pain in the past three years, were matched for age and GP. Altogether 111 eligible women were interviewed (29 cases, 82 controls).

Main results: Univariate analyses identified several significant associations with OAK including past knee injury, arthritis of the feet, heavy smoking, being overweight (BMI 25 or above) and various occupational activities. Virtually all measures of high heeled shoes use were associated with reduced risk of OAK, although none of these findings were statistically significant. In multivariate analysis only BMI 25 or above at age 36–40 remained significantly associated with OAK (OR 36.4, 95% CI 3.07 to 432, p=0.004), although weak evidence suggested certain occupational activities might increase risk. Weight gain in early adult life was particularly pronounced among cases.

Conclusions: Being overweight before the age of 40 considerably increased the risk of subsequent symptomatic OAK in women. Wearing high heeled shoes did not.

Full Text

The Full Text of this article is available as a PDF (331.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adrian M. J., Karpovich P. V. Foot instability during walking in shoes with high heels. Res Q. 1966 May;37(2):168–175. [PubMed] [Google Scholar]
  2. Bartley M. Measuring women's social position: the importance of theory. J Epidemiol Community Health. 1999 Oct;53(10):601–602. doi: 10.1136/jech.53.10.601. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Berney L. R., Blane D. B. Collecting retrospective data: accuracy of recall after 50 years judged against historical records. Soc Sci Med. 1997 Nov;45(10):1519–1525. doi: 10.1016/s0277-9536(97)00088-9. [DOI] [PubMed] [Google Scholar]
  4. Chaturvedi N., Ben-Shlomo Y. From the surgery to the surgeon: does deprivation influence consultation and operation rates? Br J Gen Pract. 1995 Mar;45(392):127–131. [PMC free article] [PubMed] [Google Scholar]
  5. Coggon D., Croft P., Kellingray S., Barrett D., McLaren M., Cooper C. Occupational physical activities and osteoarthritis of the knee. Arthritis Rheum. 2000 Jul;43(7):1443–1449. doi: 10.1002/1529-0131(200007)43:7<1443::AID-ANR5>3.0.CO;2-1. [DOI] [PubMed] [Google Scholar]
  6. Croft P. Review of UK data on the rheumatic diseases--3. Osteoarthritis. Br J Rheumatol. 1990 Oct;29(5):391–395. doi: 10.1093/rheumatology/29.5.391. [DOI] [PubMed] [Google Scholar]
  7. Felson D. T., Hannan M. T., Naimark A., Berkeley J., Gordon G., Wilson P. W., Anderson J. Occupational physical demands, knee bending, and knee osteoarthritis: results from the Framingham Study. J Rheumatol. 1991 Oct;18(10):1587–1592. [PubMed] [Google Scholar]
  8. Felson D. T., Nevitt M. C. The effects of estrogen on osteoarthritis. Curr Opin Rheumatol. 1998 May;10(3):269–272. doi: 10.1097/00002281-199805000-00019. [DOI] [PubMed] [Google Scholar]
  9. Felson D. T. The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study. Semin Arthritis Rheum. 1990 Dec;20(3 Suppl 1):42–50. doi: 10.1016/0049-0172(90)90046-i. [DOI] [PubMed] [Google Scholar]
  10. Flegal K. M., Carroll M. D., Kuczmarski R. J., Johnson C. L. Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord. 1998 Jan;22(1):39–47. doi: 10.1038/sj.ijo.0800541. [DOI] [PubMed] [Google Scholar]
  11. Gibson T., Hameed K., Kadir M., Sultana S., Fatima Z., Syed A. Knee pain amongst the poor and affluent in Pakistan. Br J Rheumatol. 1996 Feb;35(2):146–149. doi: 10.1093/rheumatology/35.2.146. [DOI] [PubMed] [Google Scholar]
  12. Hart D. J., Spector T. D. The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol. 1993 Feb;20(2):331–335. [PubMed] [Google Scholar]
  13. Jensen C. H., Rofail S. Knee injury and obesity in patients undergoing total knee replacement: a retrospective study in 115 patients. J Orthop Sci. 1999;4(1):5–7. doi: 10.1007/s007760050066. [DOI] [PubMed] [Google Scholar]
  14. Keen R. W., Hart D. J., Lanchbury J. S., Spector T. D. Association of early osteoarthritis of the knee with a Taq I polymorphism of the vitamin D receptor gene. Arthritis Rheum. 1997 Aug;40(8):1444–1449. doi: 10.1002/art.1780400812. [DOI] [PubMed] [Google Scholar]
  15. Kerrigan D. C., Todd M. K., Riley P. O. Knee osteoarthritis and high-heeled shoes. Lancet. 1998 May 9;351(9113):1399–1401. doi: 10.1016/S0140-6736(97)11281-8. [DOI] [PubMed] [Google Scholar]
  16. Leigh J. P., Fries J. F. Correlations between education and arthritis in the 1971-1975 NHANES I. Soc Sci Med. 1994 Feb;38(4):575–583. doi: 10.1016/0277-9536(94)90254-2. [DOI] [PubMed] [Google Scholar]
  17. Lequesne M. G., Dang N., Lane N. E. Sport practice and osteoarthritis of the limbs. Osteoarthritis Cartilage. 1997 Mar;5(2):75–86. doi: 10.1016/s1063-4584(97)80001-5. [DOI] [PubMed] [Google Scholar]
  18. McAlindon T. E., Cooper C., Kirwan J. R., Dieppe P. A. Knee pain and disability in the community. Br J Rheumatol. 1992 Mar;31(3):189–192. doi: 10.1093/rheumatology/31.3.189. [DOI] [PubMed] [Google Scholar]
  19. McAlindon T. E., Wilson P. W., Aliabadi P., Weissman B., Felson D. T. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med. 1999 Feb;106(2):151–157. doi: 10.1016/s0002-9343(98)00413-6. [DOI] [PubMed] [Google Scholar]
  20. Roos H., Adalberth T., Dahlberg L., Lohmander L. S. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage. 1995 Dec;3(4):261–267. doi: 10.1016/s1063-4584(05)80017-2. [DOI] [PubMed] [Google Scholar]
  21. Spector T. D., Harris P. A., Hart D. J., Cicuttini F. M., Nandra D., Etherington J., Wolman R. L., Doyle D. V. Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls. Arthritis Rheum. 1996 Jun;39(6):988–995. doi: 10.1002/art.1780390616. [DOI] [PubMed] [Google Scholar]
  22. Sutton A. J., Muir K. R., Mockett S., Fentem P. A case-control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey. Ann Rheum Dis. 2001 Aug;60(8):756–764. doi: 10.1136/ard.60.8.756. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Tennant A., Fear J., Pickering A., Hillman M., Cutts A., Chamberlain M. A. Prevalence of knee problems in the population aged 55 years and over: identifying the need for knee arthroplasty. BMJ. 1995 May 20;310(6990):1291–1293. doi: 10.1136/bmj.310.6990.1291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Zhang Y., McAlindon T. E., Hannan M. T., Chaisson C. E., Klein R., Wilson P. W., Felson D. T. Estrogen replacement therapy and worsening of radiographic knee osteoarthritis: the Framingham Study. Arthritis Rheum. 1998 Oct;41(10):1867–1873. doi: 10.1002/1529-0131(199810)41:10<1867::AID-ART20>3.0.CO;2-W. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES