HIP osteoarthritis and work




Abstract


Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by the elimination or redesign of processes and the use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where it is not attributable to employment, hip osteoarthritis impacts importantly on the capacity to work. Factors that may influence work participation include the severity of disease, the physical demands of the job, age and the size of the employer. Published research does not provide a strong guide to the timing of return to work following hip arthroplasty for osteoarthritis, and it is unclear whether patients should avoid heavy manual tasks in their future employment.


Osteoarthritis of the hip is a major cause of pain and disability in western populations. Although it is most frequent at older ages, many cases occur before retirement, when it can impact seriously on the capacity to work. As longevity increases and changes to pensions require people to remain in employment to older ages, the scale of this problem is set to grow. Furthermore, it is now well established that certain occupational activities contribute importantly to the development of the disease.


This chapter reviews the interrelationship of hip osteoarthritis with employment. We begin with a brief summary of its descriptive epidemiology and major non-occupational risk factors. We then review the evidence for occupation as a cause of the disease, and the implications for prevention and compensation. Next, we consider the impact of hip osteoarthritis on the capacity to work, including after its surgical treatment. Finally, we summarise the main conclusions that can be drawn from current evidence, and we identify priorities for further research to address important unanswered questions.


Descriptive epidemiology


The descriptive epidemiology of hip osteoarthritis has implications for the scale of its impact on employment, both currently and in the future. Evidence comes mainly from population-based surveys of symptoms and radiographic abnormalities. In addition, statistics on hospital admissions provide information about the frequency of surgical treatment for the disease (in particular by total hip replacement), although it must be recognised that rates of surgery are determined not only by the occurrence of the disorder but also by the availability of arthroplasty and criteria for performing the operation, which may differ between populations and vary over time.


Case definition


Meaningful and unambiguous case definition for hip osteoarthritis is a challenge because it occurs in a spectrum of severity with no clear dichotomy between normality and abnormality. Moreover, the dominant symptoms of pain and stiffness correlate imperfectly with more objective radiographic evidence of the underlying pathology . As with osteoarthritis in other joints, the disorder is characterised radiologically by a reduction in joint space (reflecting a loss of the articular cartilage), osteophytosis and an increased subchondral bone density with the formation of cysts. In the most severe cases, there can also be deformity of the femoral head. Many studies have graded the severity of radiographic abnormalities according to a scheme devised by Kellgren and Lawrence, using either standardised radiographs or standardised verbal descriptors as a reference. Others have used measures of joint space, such as the minimal distance between the articular surfaces . An assessment of the validity and reliability of alternative case definitions when applied to a sample of 3585 men and women aged ≥55 years indicated a higher interrater agreement and a stronger association with symptoms for those based on minimal joint space and on comparison with standard radiographs, than for diagnosis based on verbal descriptors .


Frequency by sex, age, place and time


The prevalence and distribution of hip osteoarthritis internationally was estimated as part of the Global Burden of Disease 2010 study . In a systematic review and meta-analysis, which adjusted for differences between studies in case definition, the global age-standardised prevalence of symptomatic, radiographically confirmed (Kellgren–Lawrence grades 2–4) disease in 2010 was estimated to be 0.85% (95% uncertainty interval 0.74–1.02%), with no evidence of a change since 1990. Rates were higher in women (0.98%) than in men (0.70%), and they increased progressively with age from close to zero at 30 years to ≥10% above 80 years. They were highest in North America (1.6% in men and 2.1% in women) and lowest in East Asia (0.2% in men and 0.3% in women).


In Britain, a report published by Arthritis Research UK used data from an anonymised general practice database to estimate the prevalence of diagnosed hip osteoarthritis and pain in the hip that was not associated with a diagnosis of gout, rheumatoid arthritis or fracture, among people aged ≥45 years during 2004–2010. Rates of 4% and 7% were determined for men and women aged 45–64 years. While the diagnostic criteria may have lacked specificity (not all unexplained hip pain will have been attributable to osteoarthritis), it is unlikely that all cases in the population covered by the database will have presented to their general practitioner, and comparison of the prevalence at age ≥75 years (11% in men and 16% in women) with findings from the Global Burden of Disease study suggests that estimates were reasonably accurate.


Severe hip osteoarthritis is often treated by, and is the main indication for total hip arthroplasty. During 2012–2013, some 20,000 such procedures were performed in England over a 12-month period in patients aged 45–64 years, indicating a substantial burden in the people of working age .




Non-occupational risk factors


Apart from demographic variables such as sex and age, a number of other non-occupational risk factors for hip osteoarthritis are well established ( Table 1 ). As well as contributing to disease that may then impact on capacity to work, these risk factors have potential to confound or modify the effects of occupation on the development of the disorder.



Table 1

Established non-occupational risk factors for hip osteoarthritis.




















  • Genetic predisposition




  • Developmental abnormalities of hip joint




  • Congenital dislocation of hip




  • Perthes’ disease




  • Slipped capital femoral epiphysis




  • Hip injury




  • Higher body mass index



Genetic predisposition


Twin and family studies point to an important role of genetic predisposition , especially in generalised osteoarthritis that affects multiple joints , and several molecular mechanisms have been identified that might be involved . Genetic factors may contribute to the variation in the prevalence of hip osteoarthritis that has been observed between different parts of the world .


Developmental abnormalities


Developmental abnormalities of the hip joint such as congenital dislocation, Perthes’ disease and slipped capital femoral epiphysis are associated with a clearly elevated risk of hip osteoarthritis . This is thought to occur because structural deformities alter the distribution of mechanical stresses in the joint. There is some evidence that more minor, sub-clinical acetabular dysplasia may also be a risk factor, although this is less certain .


Hip injury


Structural deformity may also occur as a consequence of traumatic injury to the hip, and there is some evidence that such injury increases the risk of later osteoarthritis . However, the link to injury is not as well established as for osteoarthritis of the knee.


Body mass index


Like other joints, the hip is more likely to be affected by osteoarthritis in people with a higher body mass index (BMI). However, the relationship is weaker than for knee osteoarthritis . A systematic review and meta-analysis that included 14 epidemiological studies indicated a relative risk of 1.11 (95% CI: 1.07–1.16) for an increase in BMI of 5 kg/m 2 . The underlying mechanism is likely to be partly mechanical, with greater stresses on the joint in people who are heavier. However, obesity may also lead to systemic changes in metabolism that predispose to osteoarthritis.


Importance as confounders


Apart from sex and age, the most important potential confounder of associations between hip osteoarthritis and occupation is BMI. Major developmental abnormalities of the hip are relatively rare, and they account for only a small proportion of cases, while genetic predisposition would not be expected to associate strongly with occupational exposures except insofar as people may give up physically demanding work if they have developed osteoarthritis. Nevertheless, some studies of occupational risk factors have adjusted for the presence of Heberden’s nodes as a marker for systemic tendency to osteoarthritis, including from genetic predisposition.




Non-occupational risk factors


Apart from demographic variables such as sex and age, a number of other non-occupational risk factors for hip osteoarthritis are well established ( Table 1 ). As well as contributing to disease that may then impact on capacity to work, these risk factors have potential to confound or modify the effects of occupation on the development of the disorder.



Table 1

Established non-occupational risk factors for hip osteoarthritis.




















  • Genetic predisposition




  • Developmental abnormalities of hip joint




  • Congenital dislocation of hip




  • Perthes’ disease




  • Slipped capital femoral epiphysis




  • Hip injury




  • Higher body mass index



Genetic predisposition


Twin and family studies point to an important role of genetic predisposition , especially in generalised osteoarthritis that affects multiple joints , and several molecular mechanisms have been identified that might be involved . Genetic factors may contribute to the variation in the prevalence of hip osteoarthritis that has been observed between different parts of the world .


Developmental abnormalities


Developmental abnormalities of the hip joint such as congenital dislocation, Perthes’ disease and slipped capital femoral epiphysis are associated with a clearly elevated risk of hip osteoarthritis . This is thought to occur because structural deformities alter the distribution of mechanical stresses in the joint. There is some evidence that more minor, sub-clinical acetabular dysplasia may also be a risk factor, although this is less certain .


Hip injury


Structural deformity may also occur as a consequence of traumatic injury to the hip, and there is some evidence that such injury increases the risk of later osteoarthritis . However, the link to injury is not as well established as for osteoarthritis of the knee.


Body mass index


Like other joints, the hip is more likely to be affected by osteoarthritis in people with a higher body mass index (BMI). However, the relationship is weaker than for knee osteoarthritis . A systematic review and meta-analysis that included 14 epidemiological studies indicated a relative risk of 1.11 (95% CI: 1.07–1.16) for an increase in BMI of 5 kg/m 2 . The underlying mechanism is likely to be partly mechanical, with greater stresses on the joint in people who are heavier. However, obesity may also lead to systemic changes in metabolism that predispose to osteoarthritis.


Importance as confounders


Apart from sex and age, the most important potential confounder of associations between hip osteoarthritis and occupation is BMI. Major developmental abnormalities of the hip are relatively rare, and they account for only a small proportion of cases, while genetic predisposition would not be expected to associate strongly with occupational exposures except insofar as people may give up physically demanding work if they have developed osteoarthritis. Nevertheless, some studies of occupational risk factors have adjusted for the presence of Heberden’s nodes as a marker for systemic tendency to osteoarthritis, including from genetic predisposition.




Work as a cause of hip osteoarthritis


Given the assumed role of mechanical loading in the development of osteoarthritis, it is plausible that risk would be increased by occupational activities that place unusual physical stresses on the hip.


Evidence for a role of occupation


Epidemiological studies have explored the association between hip osteoarthritis and various types of work and occupational activities. A systematic review published in 2012 identified 30 such investigations , 28 of which are summarised in Table 2 (the other two did not give results for osteoarthritis of the hip specifically) along with six further studies that are relevant. The total body of evidence comprises nine cohort studies, 14 case-control investigations and 11 cross-sectional surveys.



Table 2

Epidemiological studies investigating possible occupational causes of hip osteoarthritis.































































































































































































































































































































Reference Country Study design Study sample Case definition and ascertainment Exposures and methods of assessment Confounders considered Risk estimates (95% CIs)
Lindberg and Danielsson 1984 Sweden Cross-sectional 332 male shipyard workers (heavy labour), 352 male white-collar workers and 438 men from general population Previous radiograph of hip showing joint space <4 mm at <70 years, <3 mm at >70 years or ≥1 mm difference between hips Occupational group or general population Sex, age No significant differences between the three groups in the prevalence of hip osteoarthritis
Typpö 1985 Finland Case-control Cases with hip osteoarthritis and controls without, who had attended medical or surgical out-patient clinics Based on measurements of osteophyte size, minimal joint space and size of subchondral cysts in radiographs taken for various reasons Classes of work and occupation determined by questionnaire. Unclear how changes of job were handled. None 131/251 cases were heavy manual workers versus 110/254 controls
90/224 cases were farmers versus 70/255 controls
22/224 cases were construction workers versus 14/255 controls
Jacobsson et al., 1987 Sweden Cross-sectional 85 men listed for total hip arthroplasty, 21 men with urography films showing joint space <3 mm, and 190 controls with normal joint space on urography Group (a) Listed for hip arthroplasty; or Group (b) joint space<3 mm, identified from hospital records Occupational history, including physical activities, by questionnaire None Heavy labour in 84% of Group (a) and 90% of Group (b) versus 72% of controls
Farm work in 55% of Group (a) and 67% of Group (b) versus 40% of controls
Heavy lifting in 85% of Group (a) and 86% of Group (b) versus 73% of controls
Thelin 1990 Sweden Case-control 98 men aged 55–70 years with hip osteoarthritis and 201 controls from general population Surgery for hip osteoarthritis Years in farming from lifetime occupational history by postal questionnaire Sex >10 versus <1 year in farming
RR: 3.2 (1.8–5.5)
Vingård, Alfredsson et al., 1991 Sweden Cohort 207,638 men and 42,579 women from general population with same occupation in each of 1960 and 1970 censuses, followed during 1981–1983 Hospital admission for hip osteoarthritis from national discharge register Occupation at censuses and inferred exposures to dynamic and static forces on lower extremity Age, sex, county and degree of urbanisation High versus low exposure to forces on lower extremity
RR: 2.2 (1.6–2.8) in men born 1905–1924
RR: 2.0 (1.6–2.3) in men born 1925–1945
RR: 1.6 (0.9–3.1) in women born 1905–1924
RR: 1.1 (0.9–1.5) in women born 1925–1945
Farmers versus low exposure to forces on lower extremity
RR: 3.78 (2.91–3.88) in men
RR: 1.47 (0.86–2.85) in women
Construction workers versus low exposure to forces on lower extremity
RR: 1.66 (1.32–1.87) in men
Vingård, Hogstedt et al., 1991 Sweden Case-control 239 men aged 50–70 years with hip osteoarthritis and 302 controls randomly selected from general population First-time hip arthroplasty for idiopathic osteoarthritis from hospital clinics Occupational histories to age 49 years by interview, and inferred exposures to static and dynamic forces on hip Age, body mass index, smoking, sports activities up to age 29 years High versus low exposure to static and dynamic forces on hip
RR: 2.42 (1.45–4.04)
Vingård et al.,1992 Sweden Case-control 140 men with hip osteoarthritis and 298 controls from general population Receipt of disability pension with physician diagnosis of hip osteoarthritis Occupational history by interview, and inferred exposures to physical loading Age, sex High versus low exposure to forces on hip
RR: 12.4 (6.7–23.0)
Farmers or forest workers for ≥10 years versus never in exposed occupation
RR: 13.8 (4.0–48.1)
Construction worker for ≥10 years versus never in exposed occupation
RR: 5.3 (2.6–10.6)
Croft, Coggon et al., 1992 UK Cross-sectional 167 men aged 60–76 years who had farmed for ≥1 year and 83 controls from mainly sedentary jobs Joint space ≤1.5 mm or previous total hip arthroplasty Lifetime history of work in specified jobs by questionnaire Age, height, weight and Heberden’s nodes 1–9 years in farming
OR: 4.5 (0.8–26.3)
≥10 years in farming
OR: 9.3 (1.9–44.5)
Croft, Cooper et al., 1992 UK Case-control 53 men with hip osteoarthritis on intravenous urogram and 294 controls with minimum joint space ≥3.5 mm on intravenous urogram Previous total hip arthroplasty for osteoarthritis or minimum joint space ≤1.5 mm in at least one hip Lifetime occupational history including detail of specified activities, by interview Age and hospital where intravenous urogram was performed Work for ≥10 versus <1 year in farming
OR: 2.0 (0.9–4.4)
Work for ≥10 versus <1 year in construction
OR: 0.5 (0.1–2.3)
Work involving lifting/moving weights >56 lb by hand for ≥ 20 versus <1 year
OR: 2.5 (1.1–5.7)
Axmacher and Lindberg 1993 Sweden Cross-sectional 716 farmers from across Sweden and 2500 controls from general population of Malmö, all of whom had undergone radiographic examination of bowel or urinary tract Joint space <4 mm and/or osteosclerosis, cyst formation or other structural changes Work in farming versus control Age and sex Hip osteoarthritis in 45/565 male farmers versus 10/1250 controls, and in 2/151 female farmers versus 10/1250 controls
Heliövaara et al., 1993 Finland Cross-sectional 3322 men and 3895 women aged ≥30 years from general population Cases defined by standardised clinical assessment in subset with questionnaire responses suggestive of musculoskeletal diseases Exposure to each of five physically stressful activities in either current/most recent or longest duration job Age, sex, body mass index, injury to lower limb 4–5 versus 0 physically stressful activities at work
OR: 2.7 (1.7–4.4)
Roach 1994 USA Case-control 99 men >40 years with hip osteoarthritis and 233 controls with no osteoarthritis on intra-venous pyelogram Hip pain and Kellgren and Lawrence grade 3 or 4 from hospital records Years in different occupational categories from postal questionnaire Age, sex, race, previous cancer diagnosis, obesity aged 40 years, running for exercise Heavy versus light work
OR: 2.5 (1.5–5.0)
Van Dijk 1995 The Netherlands Cross-sectional 19 female former ballet dancers aged 50–70 years and 19 pair- matched controls from surgical outpatient department with no long-term sports participation or physically demanding work Measurement of joint space and grading to Hermodsson scale, using standardised radiographs Work as ballet dancer versus control Sex, age (but did not perform appropriate analysis for matched data) No significant difference in hip osteoarthritis between dancers and controls
Vingård et al.,1997 Sweden Case-control 230 women aged 50–70 years with hip osteoarthritis and 273 controls from general population without hip problems Total hip arthroplasty for primary osteoarthritis ascertained from national register Occupational history to age 50 years and associated physical activities by interview Age, body mass index, smoking, sports activities, number of children and hormone therapy High versus low exposure to heavy lifting
RR: 1.5 (0.9–2.5)
Thelin et al.,1997 Sweden Case-control 216 men with hip osteoarthritis who had undergone radiological examination of hip and 479 controls from general population Joint space <3 mm Lifetime occupational history, including specified tasks, by postal questionnaire None Worked on farm for >30 versus 0 years
OR: 4.45 (2.90–6.83)
Heavy physical work before age 16 years
OR: 2.06 (1.48–2.86)
Coggon et al.,1998 UK Case-control 210 men and 401 women aged 45–91 years with osteoarthritis and 611 controls from general population matched for sex, age and general practice Listed for total hip arthroplasty because of primary osteoarthritis Lifetime occupational history and associated physical activities up to 10 years before entry to study by interview Age, sex, body mass index, history of hip injury, Heberden’s nodes Lifting >25 kg for ≥20 versus 0 years OR: 2.3 (1.3–4.4) in men
OR: 0.8 (0.4–1.5) in women
Maximum lifted for ≥10 years ≥ 50 kg versus <10 kg
OR: 3.2 (1.6–6.5) in men
OR: 1.1 (0.5–2.5) in women
Cvijetic et al., 1999 Croatia Cross-sectional 298 men and 292 women aged ≥45 years, randomly sampled from general population Kellgren and Lawrence grade 2–4 on radiograph of right hip Categories of activity in current or most recent job determined by interview Age, sex and body mass index Jobs with high physical strain versus mostly sedentary jobs
OR: 1.15 (0.52–2.52) in men
OR: 1.34 (0.52–3.04) in women
Yoshimura et al., 2000 Japan Case-control 114 men and women aged ≥45 years with osteoarthritis, and 114 individually matched controls from general population Listed for total hip arthroplasty for primary osteoarthritis Lifting in main lifetime job by interview Age, sex, district of residence, history of knee pain and age left school Heavy lifting (weights of ≥50 kg) versus no lifting
OR: 4.1 (1.1–15.2)
Chitnavis et al., 2000 UK Cross-sectional 107 male patients with hip osteoarthritis and 52 undergoing total knee arthroplasty Total hip arthroplasty for osteoarthritis with no identifiable cause in joint replaced Work as a farmer by interview Sex 16% of men with hip osteoarthritis had worked as farmers versus 7% of men with total knee arthroplasty
Lau et al., 2000 Hong Kong Case-control 138 patients with hip osteoarthritis and 414 controls, individually matched for age and sex, from general practice clinics Attended orthopaedic clinic with primary hip osteoarthritis of Kellgren and Lawrence grade 3 or 4 Lifting in main lifetime job by interview Age, sex, height, weight, history of joint injury, regular sports activities Lifting ≥10 kg > 10 times per week in main job versus no lifting ≥10 kg
OR: 3.1 (0.7–14.3) in men
OR: 2.4 (1.1–5.3) in women
Flugsrud et al., 2002 Norway Cohort 50,034 participants in cardiovascular screening programme followed for 9 years First total hip arthroplasty for primary hip osteoarthritis Physical activity in current job at time of screening by postal questionnaire Age at screening, sex, height, body mass index, marital status, leisure time physical activity, smoking habits Intensive versus sedentary physical activity at work
RR: 2.1 (1.5–3.0) in men
RR: 2.1 (1.3–3.3) in women
Tüchsen 2003 Denmark Cohort All employed Danish men aged 20–59 in January 1981, 1986, 1991 and 1994 followed during 1981–1985, 1986–1990, 1991–1993 and 1994–1999, respectively First admission to hospital for hip osteoarthritis, ascertained from national patient register Main occupation at beginning of each follow-up period from national register Age and sex Self-employed farmers
1981–1985 SHR: 281 (259–304)
1986–1990 SHR: 283 (269–298)
1991–1993 SHR: 285 (268–302)
1994–1999 SHR: 286 (262–313)
Self-employed in agricultural tractor pools
1981–1985 SHR: 210 (97–455)
1986–1990 SHR: 200 (122–327)
1991–1993 SHR: 192 (116–315)
1994–1999 SHR: 183 (86–387)
Employees in farming and horticulture
1981–1985 SHR: 114 (89–147)
1986–1990 SHR: 138 (118–161)
1991–1993 SHR: 160 (140–183)
1994–1999 SHR: 189 (158–227)
Thelin et al., 2004 Sweden Case-control 369 farmers with hip osteoarthritis and 369 control farmers individually matched for sex, age and residential area Surgery for hip osteoarthritis or hip symptoms and joint space <3 mm, ascertained from medical files Lifetime history of farming activities by interview Handling straw, sacks, fodder and/or manure and tractor driving Work >5 h/day in animal barns since age 30 versus no work in animal barns
OR 13.3 (1.22–144.98)
No associations with daily working time, working time per year or hours of tractor driving per year
Jacobsen et al., 2004 Denmark Cross-sectional 2572 participants in Copenhagen City Heart study with no hip pain and at most only one of joint space narrowing or osteophytosis on hip radiograph Minimal joint space determined from pelvic radiographs Lifetime occupational history including levels of lifting, ascertained by questionnaire None No significant differences in mean minimal joint space by measures of occupational lifting
Thelin and Holmberg 2007 Sweden Cohort 1220 male farmers, 1130 non-farming rural residents and 1087 urban controls matched for sex and age, followed for 14 years First hospital care for hip osteoarthritis, ascertained from national register Owned or rented a farm and farmed for >25 h/week Age Farmers versus urban controls
HR: 3.0 (1.7–5.3)
Non-farming rural men versus urban controls
HR: 1.2 (0.8–1.6)
Riyazi et al., 2008 The Netherlands Case-control 93 patients with familial osteoarthritis involving hip and at least one other joint site, and 345 controls from general population Pain or stiffness in groin or hip on most days plus osteophytes or joint space narrowing on radiograph, or previous arthroplasty Lifetime occupational activities inferred from job title ascertained by questionnaire. Age, sex and body mass index Ever versus never physically demanding work
OR: 3.3 (1.3–8.2)
Järvholm et al.,2008 Sweden Cohort 204,741 men aged 15–67 years employed in construction industry, followed for up to 12 years Hospital admission for hip replacement with a diagnosis of osteoarthritis, ascertained from national register Job title reported at entry to a health control programme Age and body mass index RRs >1 for 13/14 manual occupations versus white-collar workers.
Highest RR 1.58 (0.93–2.68) for floor layers.
Juhakoski et al., 2009 Finland Cohort 371 men and 469 women from general population, free from hip osteoarthritis at baseline, followed up after 22 years Clinical diagnosis of hip osteoarthritis by physicians based on disease history, symptoms and clinical findings according to standardised criteria Physical workload at baseline based on responses to a questionnaire Sex, age, education, body mass index, smoking, alcohol, leisure time physical activity, injury Heavy manual versus light sedentary work
OR: 6.7 (2.3–19.5)
Allen et al.,2010 USA Cross-sectional 2506 men and women (mean age 63.6 years) from general population Symptomatic hip osteoarthritis defined as pain, aching or stiffness in hip on most days and Kellgren and Lawrence grade 2 + radiographic changes in same joint Lifetime exposure to specified occupational activities elicited at interview Age, race, gender, body mass index, prior hip injury, smoking and household tasks Heavy work, standing versus none in longest held job
OR: 1.75 (1.17–2.61)
Ever versus never exposed to lifting
50 kg ≥ 10 × /week
OR: 1.88 (1.20–2.92)
Franklin et al., 2010 Iceland Case-control 1008 men and women treated for hip osteoarthritis at >60 years and 1082 controls (first degree relatives of cases of hip and knee osteoarthritis) Total hip arthroplasty for osteoarthritis from patient records Longest held occupation from questionnaire Age, sex, body mass index, recreational physical activity Farmers versus managers and professionals
OR 3.6 (2.1–6.2) in men
OR: 0.62 (0.36–1.0) in women
Ratzlaff et al., 2011 Canada Cohort 2918 men and women aged 45–85 years, with no hip osteoarthritis at baseline, followed for 2 years Self-reported diagnosis of hip osteoarthritis by a health professional Cumulative lifetime occupational force on hip estimated from occupational history by online questionnaire Sex, age, earlier injury, sporting activity, domestic activity Highest versus lowest fifth of cumulative lifetime occupational force on hip
HR: 1.80 (0.95–2.82)
Kaila-Kangas et al.,2011 Finland Cross-sectional 3110 men and 3446 women from general population Clinical diagnosis of hip osteoarthritis according to standardised criteria based on disease history, symptoms and clinical findings Occupational activities in current and five longest held jobs by interview Age, sex, body mass index, smoking and traumatic fractures Manual handling of loads >20 kg for >24 versus 0 years
OR: 2.3 (1.2–4.3) in men
OR: 1.2 (0.7–2.1) in women
Andersen et al., 2012 Denmark Cohort 217,055 farmers, 487,156 construction workers and 912,228 office workers, identified from a national database over 1981–2006, and followed for up to 11 years First hip replacement surgery with a diagnosis of osteoarthritis from national patient register Occupation from national database Age, sex, calendar period, income and unemployment Farmer for >10 years versus office workers
HR: 3.00 (2.71–3.32) in men
HR: 1.62 (1.19–2.20) in women
Construction worker for >10 years versus office workers
HR: 1.83 (1.68–2.00) in men
HR: 1.57 (0.97–2.52) in women
Rubak et al.,2013 Denmark Cohort 1,010,944 men and 899,549 women from general population with ≥10 years full-time employment, followed over up to 11 years First total hip arthroplasty for primary osteoarthritis Cumulative physical workload inferred from industries of employment in national register over up to 42 years Age, sex, calendar year, socioeconomic status and county of residence Highest cumulative physical workload versus never worked in industry with intermediate or high physical workload
OR: 1.33 (1.17–1.53) in men
OR: 1.01 (0.88–1.16) in women

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Nov 10, 2017 | Posted by in RHEUMATOLOGY | Comments Off on HIP osteoarthritis and work

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