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Individual and occupational risk factors for knee osteoarthritis: results of a case-control study in Germany

André Klussmann1*, Hansjürgen Gebhardt1, Matthias Nübling2, Falk Liebers3, Emilio Quirós Perea4, Wolfgang Cordier4, Lars V von Engelhardt5, Markus Schubert5, Andreas Dávid5, Bertil Bouillon6 and Monika A Rieger78

Author Affiliations

1 Institute of Occupational Health, Safety and Ergonomics (ASER) at the University of Wuppertal, Corneliusstraße 31, 42329 Wuppertal, Germany

2 Freiburg Research Centre for Occupational and Social Medicine (FFAS), Bertoldstraße 27, 79098 Freiburg, Germany

3 Federal Institute for Occupational Safety and Health, Noeldnerstraße 40-42, 10317 Berlin, Germany

4 Centre for Orthopaedics and Rheumatology, Clinic for General Orthopaedics, Sankt Josef Hospital, Bergstraße 6-12, 42105 Wuppertal, Germany

5 Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, HELIOS Hospital Wuppertal, Heusnerstraße 40, 42283 Wuppertal, Germany

6 Department of Trauma and Orthopaedic Surgery, University of Witten/Herdecke, Hospital Cologne Merheim, Ostmerheimerstraße 200, 51109 Cologne, Germany

7 Department of Occupational Health and Environmental Medicine, Institute of General Practice and Family Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany

8 Institute of Occupational and Social Medicine, University Hospital of Tuebingen, Wilhelmstraße 27, 72074 Tuebingen, Germany

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Arthritis Research & Therapy 2010, 12:R88  doi:10.1186/ar3015

Published: 14 May 2010



A number of occupational risk factors are discussed in relation to the development and progress of knee joint diseases (for example, working in a kneeling or squatting posture, lifting and carrying heavy weights). Besides the occupational factors, a number of individual risk factors are important. The distinction between work-related and other factors is crucial in assessing the risk and in deriving preventive measures in occupational health.


In a case-control study, patients with and without symptomatic knee osteoarthritis (OA) were questioned by means of a standardised questionnaire complemented by a semi-standardised interview. Controls were matched and assigned to the cases by gender and age. Conditional logistic regression was used in analysing data.


In total, 739 cases and 571 controls were included in the study. In women and men, several individual and occupational predictors for knee OA could be described: obesity (odds ratio (OR) up to 17.65 in women and up to 12.56 in men); kneeling/squatting (women, OR 2.52 (>8,934 hours/life); men, 2.16 (574 to 12,244 hours/life), 2.47 (>12,244 hours/life)); genetic predisposition (women, OR 2.17; men, OR 2.37); and sports with a risk of unapparent trauma (women, OR 2.47 (≥1,440 hours/life); men, 2.58 (≥3,232 hours/life)). In women, malalignment of the knee (OR 11.54), pain in the knee already in childhood (OR 2.08), and the daily lifting and carrying of loads (≥1,088 tons/life, OR 2.13) were related to an increased OR; sitting and smoking led to a reduced OR.


The results support a dose-response relationship between kneeling/squatting and symptomatic knee OA in men and, for the first time, in women. The results concerning general and occupational predictors for knee OA reflect the findings from the literature quite well. Yet occupational risks such as jumping or climbing stairs/ladders, as discussed in the literature, did not correlate with symptomatic knee OA in the present study. With regards to occupational health, prevention measures should focus on the reduction of kneeling activities and the lifting and carrying of loads as well as general risk factors, most notably the reduction of obesity. More intervention studies of the effectiveness of tools and working methods for reducing knee straining activities are needed.