Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study)

Abstract

BackgroundThe relationship between leisure time physical activity (LPA) and hip and knee OA and subsequent joint replacement has not yet been clearly defined. Some studies have found the risk of knee replacement (TKR) to increase with high levels of LPA, while others have found no overall relationship to either TKR or hip replacement (THR). The aim was to investigate the association between LPA and the risk of severe end-stage OA, defined as THR or TKR due to primary OA, in a large population-based cohort.MethodsParticipants in the Nord-Trøndelag Health Study (HUNT) were followed prospectively to identify THR and TKR using the Norwegian Arthroplasty Register. Self-reported LPA was classified as inactive, low, moderate or high. The Cox proportional hazards model was used to calculate hazard ratios (HRs) according to levels of LPA with adjustments for confounding variables. Analyses were performed by age (<45, 45–59 and ≥60 years) and sex.ResultsA total of 66 964 participants (mean age 46.8 years (SD 16.3) were included in the analyses. We identified 1636 THRs and 1016 TKRs due to primary OA during 17.0 years (median) of follow-up. High LPA was significantly associated with THR for women <45 years (HR 1.78, 95 % CI 1.08–2.94) and men between 45–59 years (HR 1.53, 95 % CI 1.10–2.13) at baseline. A significant trend was found only among women < 45 years at baseline (p = 0.02). We found that LPA was significantly associated with TKR for women only (HR 1.45, 95 % CI 1.03–2.04). No measures of LPA were associated with TKR for men.ConclusionIn this population-based study, high level of LPA was associated with increased risk of THR where a significant trend of LPA was seen among women <45 years at baseline. For TKR, high LPA was associated with increased risk only in women. In contrast to previous studies, this study shows a possible association between high LPA and the risk of THR.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0937-7) contains supplementary material, which is available to authorized users.

The association between ambulatory activity, body composition and hip or knee joint replacement due to osteoarthritis: a prospective cohort study

“…In addition, a recent cross-sectional study using our same cohort showed that higher levels of AA was associated with a lower prevalence of hip cartilage damage measured by MRI 31 . In contrast, a few earlier reports suggested that PA was associated with an increased risk of HR 22,32,33 or no association with HR 9,34 .…”

“…As outlined above, there is heterogeneity of effects between AA and JR which may be due to a number of factors including: 1) heterogeneity of tools used to measure PA 9,22e24,34 ; 2) use of selfreported surveys to measure PA 8,22,23 which is less reliable because of over-reporting and moderate reproducibility 35 ; 3) diversity of study designs including caseecontrol 24 and prospective 9,22,23 studies with varying follow-up times; 4) different study populations (e.g.,: differences in age, gender, disease severity) 8,9,22e24,32,33 .…”

Knee replacement incidence and social deprivation: results from a French ecological study

“…However, the relationship between KR incidence and SES found in our study contradicts the relationship between body weight and SES described in the literature, which suggests that other factors play an important role in the relationship between KR incidence and SES. Physical activities, particularly those which lead to excessive lower extremity joint loading, are important risk factors for knee OA and KR [30,31]. According to previous studies, socioeconomic inequalities are found in physical activity.…”

Development and validation of prediction models to estimate risk of primary total hip and knee replacements using data from the UK: two prospective open cohorts using the UK Clinical Practice Research Datalink

“…Unsurprisingly, many candidate predictors of future primary THR or TKR previously identified in the literature were not routinely available within the primary care record. These included multi-item patient-reported measures of pain severity,40 41 structural disease markers from plain X-rays or MRI40 42 and measures of occupational and leisure time physical activity 43–46. It is not known if their inclusion would significantly improve model performance.…”