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. 2005 Aug;62(8):567–575. doi: 10.1136/oem.2004.017137

Osteoarthritis and meniscus disorders of the knee as occupational diseases of miners

G McMillan 1, L Nichols 1
PMCID: PMC1741064  PMID: 16046610

Abstract

Aim: To determine whether kneeling or squatting for prolonged periods is sufficiently causally associated with an increased risk of injury or degenerative disease of the knee joint as to meet the classic criteria to be considered an occupational disease of coal miners for whom these are or have been routine working postures.

Method: Systematic literature searches were made for studies relating to kneeling and squatting as part of the working environment of coal mines and the role of these postures in causation of knee disorders in coal miners, analogous occupations, populations, and communities. The working environment and potentially damaging forces on the knee when kneeling or squatting were described. Papers on the incidence or prevalence of knee disorders in occupational and other groups were scored against five criteria independently by each author, and from this a single consensus score representing the overall strength of evidence given by the research was awarded. The evidence was then weighed against the criteria for an occupational disease.

Results: Nineteen published papers were scored, the majority of which focussed on osteoarthritis as the outcome of interest. Few of the studies found focussed specifically on miners, and those that did tended to involve small numbers of subjects and were carried out before 1960, when the mining population was at its largest but epidemiological evidence of the risk factors for knee disorders was not well established. The non-mining studies in the review represent groups of workers with a similar or lesser kneeling content in their work.

Conclusion: The papers reviewed provide sufficient evidence to conclude that work involving kneeling and/or squatting is causally associated with an increased risk of osteoarthritis of the knee. In some of the more recent epidemiologically sound studies, frequent or prolonged kneeling or squatting doubles the general risk of osteoarthritis of the knees found in the general population. This may be of particular importance in welfare and medico-legal situations. There was also evidence to suggest that lifting, in combination with kneeling/squatting, an activity also performed by miners in the course of their work, is associated with an excess risk of osteoarthritis above that attributed to kneeling/squatting alone.

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Selected References

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  1. ATKINS J. B. Internal derangement of the knee joint in miners. Br J Ind Med. 1957 Apr;14(2):121–126. doi: 10.1136/oem.14.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Andersen R. E., Crespo C. J., Ling S. M., Bathon J. M., Bartlett S. J. Prevalence of significant knee pain among older Americans: results from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc. 1999 Dec;47(12):1435–1438. doi: 10.1111/j.1532-5415.1999.tb01563.x. [DOI] [PubMed] [Google Scholar]
  3. Anderson J. A. Arthrosis and its relation to work. Scand J Work Environ Health. 1984 Dec;10(6 Spec No):429–433. doi: 10.5271/sjweh.2301. [DOI] [PubMed] [Google Scholar]
  4. Anderson J. J., Felson D. T. 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. Am J Epidemiol. 1988 Jul;128(1):179–189. doi: 10.1093/oxfordjournals.aje.a114939. [DOI] [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. Cooper C., McAlindon T., Coggon D., Egger P., Dieppe P. Occupational activity and osteoarthritis of the knee. Ann Rheum Dis. 1994 Feb;53(2):90–93. doi: 10.1136/ard.53.2.90. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cooper C., McAlindon T., Snow S., Vines K., Young P., Kirwan J., Dieppe P. Mechanical and constitutional risk factors for symptomatic knee osteoarthritis: differences between medial tibiofemoral and patellofemoral disease. J Rheumatol. 1994 Feb;21(2):307–313. [PubMed] [Google Scholar]
  8. Cooper C. Occupational activity and the risk of osteoarthritis. J Rheumatol Suppl. 1995 Feb;43:10–12. [PubMed] [Google Scholar]
  9. Davis M. A., Ettinger W. H., Neuhaus J. M., Cho S. A., Hauck W. W. The association of knee injury and obesity with unilateral and bilateral osteoarthritis of the knee. Am J Epidemiol. 1989 Aug;130(2):278–288. doi: 10.1093/oxfordjournals.aje.a115334. [DOI] [PubMed] [Google Scholar]
  10. Felson D. T. Do occupation-related physical factors contribute to arthritis? Baillieres Clin Rheumatol. 1994 Feb;8(1):63–77. doi: 10.1016/s0950-3579(05)80225-0. [DOI] [PubMed] [Google Scholar]
  11. Felson D. T. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev. 1988;10:1–28. doi: 10.1093/oxfordjournals.epirev.a036019. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. Felson D. T., Naimark A., Anderson J., Kazis L., Castelli W., Meenan R. F. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987 Aug;30(8):914–918. doi: 10.1002/art.1780300811. [DOI] [PubMed] [Google Scholar]
  14. 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]
  15. Felson D. T., Zhang Y., Anthony J. M., Naimark A., Anderson J. J. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med. 1992 Apr 1;116(7):535–539. doi: 10.7326/0003-4819-116-7-535. [DOI] [PubMed] [Google Scholar]
  16. Hannan M. T., Felson D. T., Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol. 2000 Jun;27(6):1513–1517. [PubMed] [Google Scholar]
  17. Hochberg M. C. Epidemiology of osteoarthritis: current concepts and new insights. J Rheumatol Suppl. 1991 Feb;27:4–6. [PubMed] [Google Scholar]
  18. Huang M. H., Chen C. H., Chen T. W., Weng M. C., Wang W. T., Wang Y. L. The effects of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity. Arthritis Care Res. 2000 Dec;13(6):398–405. doi: 10.1002/1529-0131(200012)13:6<398::aid-art10>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  19. Jackson J. P. Degenerative changes in the knee after meniscectomy. Br Med J. 1968 Jun 1;2(5604):525–527. doi: 10.1136/bmj.2.5604.525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Jensen L. K., Eenberg W. Occupation as a risk factor for knee disorders. Scand J Work Environ Health. 1996 Jun;22(3):165–175. doi: 10.5271/sjweh.127. [DOI] [PubMed] [Google Scholar]
  21. Jensen L. K., Mikkelsen S., Loft I. P., Eenberg W., Bergmann I., Løgager V. Radiographic knee osteoarthritis in floorlayers and carpenters. Scand J Work Environ Health. 2000 Jun;26(3):257–262. doi: 10.5271/sjweh.540. [DOI] [PubMed] [Google Scholar]
  22. Johnson R. J., Kettelkamp D. B., Clark W., Leaverton P. Factors effecting late results after meniscectomy. J Bone Joint Surg Am. 1974 Jun;56(4):719–729. [PubMed] [Google Scholar]
  23. KELLGREN J. H., LAWRENCE J. S. Rheumatism in miners. II. X-ray study. Br J Ind Med. 1952 Jul;9(3):197–207. doi: 10.1136/oem.9.3.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Kivimäki J., Riihimäki H., Hänninen K. Knee disorders in carpet and floor layers and painters. Scand J Work Environ Health. 1992 Oct;18(5):310–316. [PubMed] [Google Scholar]
  25. Kohatsu N. D., Schurman D. J. Risk factors for the development of osteoarthrosis of the knee. Clin Orthop Relat Res. 1990 Dec;(261):242–246. [PubMed] [Google Scholar]
  26. LAWRENCE J. S., AITKEN-SWAN J. Rheumatism in miners. Part I: Rheumatic complaints. Br J Ind Med. 1952 Jan;9(1):1–18. doi: 10.1136/oem.9.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. LAWRENCE J. S. Rheumatism in coal miners. III. Occupational factors. Br J Ind Med. 1955 Jul;12(3):249–261. doi: 10.1136/oem.12.3.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Liddell F. D. Morbidity of British coal miners in 1961-62. Br J Ind Med. 1973 Jan;30(1):1–14. doi: 10.1136/oem.30.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Lindberg H., Montgomery F. Heavy labor and the occurrence of gonarthrosis. Clin Orthop Relat Res. 1987 Jan;(214):235–236. [PubMed] [Google Scholar]
  30. Maetzel A., Mäkelä M., Hawker G., Bombardier C. Osteoarthritis of the hip and knee and mechanical occupational exposure--a systematic overview of the evidence. J Rheumatol. 1997 Aug;24(8):1599–1607. [PubMed] [Google Scholar]
  31. Manninen Pirjo, Heliövaara Markku, Riihimäki Hilkka, Suoma-Iainen Olavi. Physical workload and the risk of severe knee osteoarthritis. Scand J Work Environ Health. 2002 Feb;28(1):25–32. doi: 10.5271/sjweh.643. [DOI] [PubMed] [Google Scholar]
  32. Miranda H., Viikari-Juntura E., Martikainen R., Riihimäki H. A prospective study on knee pain and its risk factors. Osteoarthritis Cartilage. 2002 Aug;10(8):623–630. doi: 10.1053/joca.2002.0796. [DOI] [PubMed] [Google Scholar]
  33. O'Reilly S. C., Muir K. R., Doherty M. Occupation and knee pain: a community study. Osteoarthritis Cartilage. 2000 Mar;8(2):78–81. doi: 10.1053/joca.1999.0274. [DOI] [PubMed] [Google Scholar]
  35. Peyron J. G. Is osteoarthritis a preventable disease? J Rheumatol Suppl. 1991 Feb;27:2–3. [PubMed] [Google Scholar]
  36. ROANTREE W. B. A review of 102 cases of beat conditions of the knee. Br J Ind Med. 1957 Oct;14(4):253–257. doi: 10.1136/oem.14.4.253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. SHARRARD W. J. Aetiology and pathology of beat knee. Br J Ind Med. 1963 Jan;20:24–31. doi: 10.1136/oem.20.1.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. SHARRARD W. J., LIDDELL F. D. Injuries to the semilunar cartilages of the knee in miners. Br J Ind Med. 1962 Jul;19:195–202. doi: 10.1136/oem.19.3.195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. SHARRARD W. J. PRESSURE EFFECTS ON THE KNEE IN KNEELING MINERS. Ann R Coll Surg Engl. 1965 Jun;36:309–324. [PMC free article] [PubMed] [Google Scholar]
  40. Sahlström A., Montgomery F. Risk analysis of occupational factors influencing the development of arthrosis of the knee. Eur J Epidemiol. 1997 Sep;13(6):675–679. doi: 10.1023/a:1007310804161. [DOI] [PubMed] [Google Scholar]
  41. Salaffi F., Cavalieri F., Nolli M., Ferraccioli G. Analysis of disability in knee osteoarthritis. Relationship with age and psychological variables but not with radiographic score. J Rheumatol. 1991 Oct;18(10):1581–1586. [PubMed] [Google Scholar]
  42. Sandmark H., Hogstedt C., Vingård E. Primary osteoarthrosis of the knee in men and women as a result of lifelong physical load from work. Scand J Work Environ Health. 2000 Feb;26(1):20–25. doi: 10.5271/sjweh.505. [DOI] [PubMed] [Google Scholar]
  43. Vingård E., Alfredsson L., Goldie I., Hogstedt C. Occupation and osteoarthrosis of the hip and knee: a register-based cohort study. Int J Epidemiol. 1991 Dec;20(4):1025–1031. doi: 10.1093/ije/20.4.1025. [DOI] [PubMed] [Google Scholar]
  44. WATKINS J. T., HUNT T. A., FERNANDEZ R. H., EDMONDS O. P. A clinical study of beat knee. Br J Ind Med. 1958 Apr;15(2):105–109. doi: 10.1136/oem.15.2.105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Wickström G., Hänninen K., Mattsson T., Niskanen T., Riihimäki H., Waris P., Zitting A. Knee degeneration in concrete reinforcement workers. Br J Ind Med. 1983 May;40(2):216–219. doi: 10.1136/oem.40.2.216. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. van Saase J. L., Vandenbroucke J. P., van Romunde L. K., Valkenburg H. A. Osteoarthritis and obesity in the general population. A relationship calling for an explanation. J Rheumatol. 1988 Jul;15(7):1152–1158. [PubMed] [Google Scholar]

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