Occupational mechanical load and severity of knee osteoarthritis: a cross-sectional analysis

Mohammad Imtiaz Sultan; Protyay Dey; M. Saiful Arif; Mohammed Taherul Islam; Aparna Deb; Ananya Bhattacharjee; M. Toufiqul Islam; M. Jaber Abedin; Mohammad Kafil Uddin Chowdhery; M. Salman Ibna Zaman; Mrinal Saha

doi:10.18203/2320-6012.ijrms20260604

Authors

Mohammad Imtiaz Sultan Department of Rheumatology, Kurmitola General Hospital, Dhaka, Bangladesh
Protyay Dey Department of Nephrology, Chittagong Medical College, Chittagong, Bangladesh
M. Saiful Arif Department of Rheumatology, Chittagong Medical College, Chittagong, Bangladesh
Mohammed Taherul Islam Department of Medicine, Chittagong Medical College Hospital, Chittagong, Bangladesh
Aparna Deb Department of Medicine, Upazila Health Complex, Fatikchari, Chittagong, Bangladesh
Ananya Bhattacharjee Department of Medicine, BIRDEM General Hospital, Shahbagh, Dhaka, Bangladesh
M. Toufiqul Islam Department of Biochemistry, Chittagong Medical College Hospital, Chittagong, Bangladesh
M. Jaber Abedin Department of Medicine, 250 Bed General Hospital, Feni, Bangladesh
Mohammad Kafil Uddin Chowdhery Department of Rheumatology, Kurmitola General Hospital, Dhaka, Bangladesh
M. Salman Ibna Zaman Department of Medicine, Kurmitola General Hospital, Dhaka, Bangladesh
Mrinal Saha Department of Medicine, Upazila Health Complex, Companigonj, Noakhali, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260604

Keywords:

Knee osteoarthritis, Occupational mechanical load, WOMAC score, Disease severity, Squatting

Abstract

Background: Knee osteoarthritis (OA) is a leading cause of pain and disability worldwide. While occupational physical activity is recognized as a risk factor for knee OA, limited evidence exists on how specific occupational mechanical loads independently influence disease severity. This study aimed to evaluate the association between cumulative occupational mechanical load and severity of knee OA using WOMAC-based outcomes. The objective of the study was to identify independent occupational mechanical load factors associated with increased severity of knee OA using WOMAC-based regression analysis.

Methods: A hospital-based cross-sectional study was conducted among 200 patients with clinically and radiologically confirmed knee OA at a tertiary care center in Bangladesh. Disease severity was categorized using total WOMAC score into low, moderate, and severe groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of increased OA severity.

Results: The majority of patients had moderate (70%) or severe (26%) WOMAC scores. On univariate analysis, increasing age, rural residence, prolonged exposure to squatting and lifting weight, higher daily walking distance. In multivariate analysis, increasing age (adjusted OR 1.18, p<0.001), longer duration of occupational squatting (adjusted OR 1.08 per year, p=0.001), and higher daily walking distance (adjusted OR 1.30 per mile/day, p=0.017) remained independent predictors of disease severity.

Conclusion: Cumulative occupational mechanical load plays a significant role in determining the severity of knee osteoarthritis. Prolonged squatting and high daily walking exposure emerged as key independent occupational predictors, highlighting the importance of early occupational risk identification and targeted preventive interventions.

Metrics

Metrics Loading ...

References

Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: Estimates from the Global Burden of Disease. Ann Rheum Dis. 2014;73(1):1323-30. DOI: https://doi.org/10.1136/annrheumdis-2013-204763

Zhang W, Doherty M, Peat G, Bierma-Zeinstra SMA, Arden NK, Bresnihan B, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis. 2010;69(3):483-9. DOI: https://doi.org/10.1136/ard.2009.113100

Felson DT, Hannan MT NA. Occupational physical demands, knee bending and knee osteoarthritis: results from the Framingham study. J Rheumatol. 1991;18:1587-92.

McWilliams DF, Leeb BF, Muthuri SG, Doherty M, Zhang W. Occupational risk factors for osteoarthritis of the knee: A meta-analysis. Osteoarthr Cartil. 2011;19(7):829-39. DOI: https://doi.org/10.1016/j.joca.2011.02.016

Palmer KT. Occupational activities and osteoarthritis of the knee. Br Med Bull. 2012;102(1):147-70. DOI: https://doi.org/10.1093/bmb/lds012

Jensen LK. Knee osteoarthritis: Influence of work involving heavy lifting, kneeling, climbing stairs or ladders, or kneeling/squatting combined with heavy lifting. Occup Environ Med. 2008;65(2):72-89. DOI: https://doi.org/10.1136/oem.2007.032466

Cubukcu D, Sarsan A, Alkan H. Relationships between Pain, Function and Radiographic Findings in Osteoarthritis of the Knee: A Cross-Sectional Study. Arthritis. 2012;2012:1-5. DOI: https://doi.org/10.1155/2012/984060

Haq SA, Darmawan J, Islam MN, UddIn MZ, Das BB RF. Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study. J Rheumatol. 2005;32:348-53.

McAlindon TE, Wilson PW, Aliabadi P, Weissman B FD. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med. 1999;106(2):151-7. DOI: https://doi.org/10.1016/S0002-9343(98)00413-6

Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, et al. Prevalence of hip symptoms and radiographic and symptomatic hip osteoarthritis in African Americans and Caucasians: The Johnston County osteoarthritis project. J Rheumatol. 2009;36(4):809-15. DOI: https://doi.org/10.3899/jrheum.080677

Coggon D, Croft P, Kellingray S, Barrett D, McLaren M CC. Occupational physical activities and osteoarthritis of the knee. Arthritis Rheum. 2000;43(7):1443-9. DOI: https://doi.org/10.1002/1529-0131(200007)43:7<1443::AID-ANR5>3.0.CO;2-1

Seidler A, Bolm-Audorff U, Abolmaali N EG. The role of cumulative physical work load in symptomatic knee osteoarthritis – a case-control study in Work. J Occup Med Toxicol. 2008;3(14). DOI: https://doi.org/10.1186/1745-6673-3-14

Gouttebarge V, Inklaar H, Backx F, Kerkhoffs G. Prevalence of osteoarthritis in former elite athletes: a systematic overview of the recent literature. Rheumatol Int. 2015;35(3):405-18. DOI: https://doi.org/10.1007/s00296-014-3093-0