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RISK FACTORS IN THE DEVELOPMENT OF KNEE OSTEOARTHRITIS: A CASE-

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 January-June 2015 Int. J Rehabil. Sci. Volume 04, Issue 01

Original Article
RISK FACTORS IN THE DEVELOPMENT OF KNEE
OSTEOARTHRITIS: A CASE-CONTROL STUDY
Anam Aftab, Furqan Ahmed Siddiqui, Muhammad Naveed Babur, Amir Rauf Memon

Abstract
Aim & Objectives: This study aims to investigate various risk factors associated with development of knee
osteoarthritis.
Methodology: A case control study was conducted from March 2014 to August 2014 on population of Farash
Town, Islamabad. Sample was collected through simple random sampling and data was collected using a
questionnaire. There were 25 cases and 75 controls in this study and data was analyzed through SPSS version-20.
Results: We found increased risk of knee osteoarthritis associated with obesity, prolong standing, female gender,
bare foot walking, occupation, past history of knee injury, heavy activity more than four hour, sustained knee
bending, positive family history of knee or other joint diseases, stair climbing, sitting on the floor for home activity,
and use of high heeled shoes.
Conclusion: These risk factors should be communicated to exposed individuals so that they should avoid them and
consequently knee osteoarthritis. We concluded that people are predisposed to multiple risk factors for developing
knee osteoarthritis in our study population.
Keywords: bare foot walking, obesity, osteoarthritis, physical activity

1. Incharge DPT, IIRS Isra Unversity Islamabad

Introduction
Osteoarthritis (OA) is a chronic disorder
affecting synovial joints. It is a progressive disease
and ultimately causes degeneration of joints1. In
osteoarthritis the joint cartilage is broken down that
eventually causes loss of cartilage in more than one
joint2. Osteoarthritis mostly affects large joints like
hip, knee and other joints of spine, feet and hands3.
Osteoarthritis occurrence increases with age. The
occurrence rate is increasing day by day in all the
countries mostly affecting the older age people4.
Osteoarthritis affects more than 40% of the western
geriatric population and knee joint is most commonly
affected joint5. Approximately 200 new cases per
100000 are diagnosed with hip or knee osteoarthritis6.
Both male and female are equally affected
by osteoarthritis but in females more joints are
affected as compared to male7. There is a rise in
overall occurrence from 30 years of age such that
65.80% of people have some radiographic changes
related to osteoarthritis but only 25-30% of these
people show the symptoms associated with
osteoarthritis8. In relation to the age, joint and the
muscles, hormonal changes, congenital
abnormalities, obesity and any previous joint trauma
causing muscle weakness and joint instability are the
causes of development of O.A9.
2. Associate Dean Department of DPT, FU Islamabad
3. Associate Professor, IIRS Isra University Islamabad
4. Lecturer, IIRS Isra University Islamabad
Correspondence
Anam Aftab, Incharge DPT, IIRS Isra University Islamabad.
e-mail: anamaftab@yahoo.com
Knee osteoarthritis is a common
musculoskeletal condition affecting females and
elderly leading to prolonged disability and reduced
quality of life. As this disease produces prolonged
physical disability so it also causes significant
economic burden on health care system10. It is the
forth in women and eighth in men of the most
common health problems everywhere in the world11.
Of all the large joints of the body the knee joint is
most commonly affected and affecting major daily
activities like climbing stairs, rising from chair,
prolonged standing and walking12. The exact cause of
knee osteoarthritis however is unknown and is
idiopathic in most of cases13. Knee OA pain is well
localized to the anterior or medial aspects of the knee
and upper tibia. Pain is aggravated by prolongation of
work, exertion and relieved by taking rest. Also,
reduced ROM and crepitus are frequently present.
Stiffness during rest may develop, with morning joint
stiffness usually lasting for less than thirty minutes.
These factors encouraged the researchers to
conduct this study. The objective of this study was

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 January-June 2015 Int. J Rehabil. Sci. Volume 04, Issue 01

identification of the risk factors involved in knee surgery or those who were unconscious and with
osteoarthritis in people living at Farash Town, cognitive problem were excluded from the study.
Islamabad. The study was approved by ethical review
committee of the institution. Moreover, all the
Methods participants of study were informed about the
objectives of the study verbally and consent form was
It was a case control study conducted in Al-
signed by all the participants. The authors strictly
Nafees Medical College Hospital, Farash Town
maintained the confidentiality and participant name
Islamabad during March 2014 and August 2014. A
or addresses were kept confidential. After a thorough
total of 100 individuals were included in the study,
literature review, data collection was done through
which were divided into cases and controls. There
questionnaire on demographic information and
were 25 cases and 75 controls randomly selected
assessment tools for risk factors of knee
through convenient sampling. The inclusion criteria
osteoarthritis.
were: patients with knee osteoarthritis visiting
We measured association between risk
physiotherapy department of Al-Nafees Medical
factor exposure and knee OA occurrence by using
College Hospital, Islamabad for treatment, patients
odds ratio. Demographic data was analyzed in
diagnosed by X-ray or MRI with knee pain, patients
descriptive statistics whereas odds ratio was used to
between the ages 30 to 80 years and those willing to
determine risk in presence of certain exposure and
be part of the study. Moreover, patients with hip
occurrence of disease. The data was entered and
osteoarthritis and other serious associated diseases,
analyzed by SPSS version-20.
patients who had undergone knee replacement

Results
Table 1: Demographic information of population under study
Demographic Variable % (N)
30-40 years 05% (05)
41-50 years 20% (20)
Age 51-60 years 55% (55)
61-80 years 21% (21)
Male 34% (34)
Gender Female 67% (67)
Uneducated 38% (38)
Less than primary education 27% (27)
Primary education 16% (16)
Secondary education 15% (15)
Educational Status Higher secondary education 01% (01)
Bachelors degree 02% (02)
Masters degree 02% (02)
Farmer 10% (10)
Garment worker 04% (04)
Driver 07% (07)
Businessman 03% (03)
Labor 13% (13)
Occupation Housewife* 44% (44)
Teacher 12% (12)
Unemployed 04% (04)
Other occupation 03% (03)

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 January-June 2015 Int. J Rehabil. Sci. Volume 04, Issue 01

Table 2: The individual factors of knee osteoarthritis results

Name of the factors Cases Controls ODD Ratio (OR) 95% CI
BMI (over weight) 16 11 11.636 4.020, 33.681
Prolong standing 16 12 9.33 3.353, 25.980
Sex (female) 24 09 6.303 1.008, 18.020
Bare foot walking 16 13 8.478 3.081, 23.328
Occupation( knee use mostly) 15 20 4.125 1.595, 10.664
Past history of painful knee injury 14 20 3.5 1.365, 8.969
Duration of Heavy activity
>4 hours 15 24 3.187 1.250, 8.125
Sustained Knee bending 08 11 2.738 0.952,7.872
Positive family history of
knee or other joint diseases 07 11 2.262 0.766, 6.678
Stair climbing 10 15 2.666 1.000, 7.105
Sitting on the floor 11 21 2.020 0.791, 5.156
for home activity
Use of high heeled Shoes 03 05 1.294 0.483, 3.461

Discussion
The total participants were 100 in this study
in which there were 75 controls and 25 cases that
meant case: control ratio was 1:3. Previous research
has found that middle-aged women had a higher
prevalence of moderate-to-severe knee osteoarthritis.
The study showed that prevalence rates of knee
osteoarthritis vary according to study population as
well as the methods applied for diagnosis14. Another
study extends the current knowledge about
osteoarthritis of the knee to include elderly subjects,
and shows that the prevalence of knee OA increases
with increasing age throughout the elderly years15.
This study showed that there exist a positive
association between osteoarthritis of knee joint and
BMI of participants, it is seen that obese people have
11.63 times more chance to have osteoarthritis. One
twin study found a 9– 13% increased risk for the
onset of the disease with every kilogram increase in
body weight16. Moreover, it was seen that it is 9.33
times likely to occur knee osteoarthritis because of
prolong standing. A previous study showed prolongs
standing in occupation or recreational activities are a
factor of knee osteoarthritis17.
In a study on prevalence of Knee OA
conducted in rural Japan, multivariable analysis
showed age, gender, underground work history,
dietary bias, body mass index and concomitant
cardiovascular diseases are risk factors for
osteoarthritis of knee in rural Shanxi18. Another
study found that obesity (OR 17.9, 95% CI; 2.4–
132.1) and current smoking (OR 7.7, 95% CI; 2.4–
24.3) were associated with symptomatic radiographic
knee osteoarthritis. Severity of involvement of knee
was associated with obesity (OR 12.0, 95% CI; 2.3–
60.9), old age (OR 3.8, 95% CI; 1.3–5.1), and older
age at ordainment (OR 2.8, 95% CI; 1.3–6.1)19.
The duration of this study was limited up to
six months, which is less time period so it is
recommended that further study should be carried out
on this topic, and it should involve use of large
sample size and carried out at different districts of
Pakistan. This study was conducted on Farash Town
population; the people of this population have low
socioeconomic status. In future such a research
should also be conducted on high socioeconomic
status population to have a better understanding of
risk factors of knee OA in general population.
Conclusion
We concluded that people are predisposed to
multiple risk factors for developing knee
osteoarthritis in our study population. By
modification of daily activities, risk factors leading to
knee OA development can be substantially reduced.
Maintaining correct working posture, correcting
faulty ergonomics and care during occupational and
daily activities may help reduce the risk of
developing knee osteoarthritis. Moreover, this study
will provide a basic ground work for the
physiotherapy interventional prevention and
management of knee osteoarthritis.

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 January-June 2015 Int. J Rehabil. Sci.
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