INCIDENCE OF OSTEOARTHRITIS OF KNEE JOINT IN …journal-archieves23.webs.com/287-302.pdf ·...

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INTERDISCIPLINARY JOURNAL OF CONTEMPORARY RESEARCH IN BUSINESS

COPY RIGHT © 2012 Institute of Interdisciplinary Business Research

287

SEPTEMBER 2012

VOL 4, NO 5

INCIDENCE OF OSTEOARTHRITIS OF KNEE JOINT IN OBESE

FEMALES

Sarah Ehsan1,Muhammad Salman Bashir

2, Arshad Nawaz Malik

3

School o f Al l i ed Heal th Scien ces Chi l dren Ho spi t a l Lahore , Assis tan t P rofessor Riphah In te rna t ional

Univer s i t y Lahore , Assi s t an t P rofessor Riphah In te rnat ional Univers i t y Is lamab ad ,

ABSTRACT

Introduction: Osteoarthritis (OA), a common joint disorder, is due to aging and

wear and tear on a joint. Being overweight increases the risk of OA in differ ent

joints. Knee osteoarthritis is the most common type. Obesity is a risk factor for

the onset, progression, and symptoms of knee osteoarthritis. Other risk factors

are aging, family his tory, menopause and female gender. Current study was

aimed at investigating the relationship between obesity, menopause and family

history with the increased incidence of osteoarthritis of knee in females.

Objective: To assess whether obesity, family history and menopause explain the

trend in knee pain and osteoarthritis in females . Methodology : Observational

study was conducted at the department of Orthopedics, Lahore general hospital

and department of Physiotherapy, Pakistan society for the rehabilitatio n of

disabled. 50 females between the ages of 45 and 65 years completed a

questionnaire regarding their knee pain and the other associated symptoms if

present. Results: Results showed that out of 50 females 96% of the obese

females developed symptomatic os teoarthritis of knee. Highest percentage was

found for bilateral knee osteoarthri tis . Chi -square tests showed significant

association between increased BMI and osteoarthritis of knee (p=0.001).

Association between Family history and knee osteoarthritis was week (p=0.024)

moreover menopause also showed weak association with knee (p=0.034). Results

show that obesity is strongly associated with development of symptomatic OA

of knee in females however menopause and family history do not seem to be

strongly associated with symptomatic OA of knee.

Key words: OA (Osteoarthritis), BMI (body mass index)

http://osteoarthritis.about.com/od/kneeosteoarthritis/

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INTRODUCTION:

Osteoarthritis is a common chronic disease that leads to joint symptoms and

signs which are associated with defective integrity of articular cartilage, related

changes in the underlying bones, joint margins and pain [ 1 , 2 ]

The predominant risk factors are age, obesity, previous trauma (particularly in

men), and activities requiring repeated knee bends. One study showed obesity to

result in an odds ratio of about 8.0 for developing OA knee [ 3 ]

Statist ically significant relationships have been found between even small

increases in body mass index (BMI) and the prevalence of this disease. [ 4 ]

Obesity, defined by either increased weight (kg) or BMI, is an une quivocal risk

factor for the onset , progression, and symptoms of knee osteoarthritis (OA).

Moreover, maintaining an ideal body weight or BMI reduces the risk for the

onset of knee OA, and a reduction in either weight or BMI helps alleviate pain

and disabil ity in people with established disease. [ 5 ]

Cartilage and other biological tissues were not constructed to effectively

cushion the joints of obese and morbidly obese individuals during locomotion.

The high-magnitude, repetitive loads that the knee sustains can lead to knee

osteoarthrit is (OA). The abili ty of carti lage to self -repair is poor and, over time,

the degenerative process of cartilage deterioration exposes the subchondral bone

and can lead to joint pain and osteoarthrit is. The pain and discomfort associated

with knee OA brings the problem full -circle as these issues further limit

mobility and the ability to exercise for weight loss, which further exacerbates

the problem of obesity. [ 6 , 7 , 8 , ]

METHODOLOGY:

Study design:

Observational study (Cross sectional survey)

Sample design:

Convenience Sampling

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Settings:

Data was taken from the Department of Orthopedics General Hospital Lahore

and Department of Physiotherapy Pakistan Society for The Rehabilitation of

Disabled

Duration of study:

3 months after the approval of synopsis.

Study group:

Females 45 to 65 years of age.

Sample size:

This was a time based study of 3 months. 50 patients were included in that

period of time.

Sampling Technique:

Convenient and Purposive Non Random Sampling technique w as used.

Sample selection criteria:

Inclusion criteria:

Females

45-65 years of age

Exclusion criteria:

All other persons who were not fulfi lling the above mentioned criteria were

excluded. Participants were excluded if they had any specific medical conditio n

affecting the knee joint (such as, tumors, septic arthritis, or rheumatoid

arthritis)

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Methodology:

A complete assessment included:

Patient history

Physical examination

Imaging studies

Patient history:

It included:

Physical activity level of the patient .

If the onset of pain was sudden or gradual.

If the pain pattern changed since i t first started.

Situations that may make the pain worse

What gives relief from the pain?

Other joints affected by osteoarthritis .

Family history of osteoarthritis.

Physical examination:

During the physical examination for osteoarthritis (OA) of the knee, the knee

was palpated to assess any swelling and to note various movements which may

bring on pain. More over the level of obesity of the patient was also checked by

calculating the BMI, using the formula:

BMI=weight in kilograms/Height in meters2

In addition, since the knee is intimately related to the proper alignment of the

entire skeletal system, following points were also assessed:

Proper spinal alignment and posture

Entire limb of the affected knee

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Diagnostic results:

The above mentioned criterion was used to diagnose OA of knee.

DATA COLLECTION TOOLS/INSTRUMENTS:

Structure questioner guide was used to collect data. From these questionnaire

data was collected about patients, gender, age and medical history of disease

STATISTICAL ANALYSIS:

Using SPSS v.17 the data was managed and analyzed. The continuous variables

were expressed as mean S.D. where as categorical variable were expressed in

the form of frequency table and percentages. The Histogram was also used to

see the normality of quantitative data. Chi -square test was applied to determine

any association between variables. Appropriate graphs were used to display the

data. A p-value less than 0.05 was taken as significant.

.

D i a g n o s t i c C l i n i c a l f e a t u r e s

1. Knee pain for most days of the month

2. Crepitus on active joint motion

3. Morning stiffness # 30 min in duration

4. Age>38 years

5. Bony enlargement of the knee on examination

OA present if items 1, 2, 3, 4, or 1, 2, 5 or 1, 4, 5 are

present

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RESULTS:

This observational study was based on 3 months’ time period and data was

collected from 50 females between the ages of 45 a nd 65. A Performa was used

for each person, in which individual demographic characteristics and cl inical

features of osteoarthritis of knee were evaluated

Mean age, height and weight of the females were 53.2200 ± 6.70452(SD),

1.6194 ± .09148(SD) and 81.5800 ± 16.39075(SD) respectively.

Among 50 females 58% females were obese, 26% were overweight and

16% were of normal BMI.

80% of the subjects were diagnosed with osteoarthrit is of knee.

Highest percentage for the knee effected, in those diagnosed with the

disease was for bilateral (48%) closely followed by right knee (42%) and

only 10% had left unilateral disease.

In all diagnosed subjects highest frequencies were seen for pain in knee

joint, morning stiffness, swelling, crepitation , difficulty in climbing

stairs and weak quadriceps.

Frequencies of variables in all subjects showed that 68% of all the

subjects were postmenopausal, 52% had a positive family history and

80% had pain in knee joint.

Significant association (p=0.001) was found between increased BMI and

osteoarthrit is of knee.

There is weak association (p=0.024) between family history and

osteoarthrit is of knee.

Weak association (p=0.034) exists between menopause and osteoarthritis

of knee.

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DISCUSSION:

The purpose of this study was to examine the role of obesity

(described in terms of increased BMI) in the development of sym ptomatic

osteoarthrit is of knee joint that would help in planning proper interventions and

would also help control this modifiable risk factor of osteoarthritis of knee.

This study shows that 96% of the obese females developed symptomatic

OA of knee and obesity is strongly associated with KOA.

As compared to menopause and family history, obesity is the most

important risk factor in the development of symptomatic OA of knee. Increased

BMI leads to increased loading forces on the kne e causing knee pain and

arthritic changes.

This study proves that the most common clinical features of osteoarthritis

of knee are pain in knee with activity, morning stiffness, swelling and

crepitation.

Most of the females with diagnosed OA of knee joint w ere obese.

Majority of the females with diagnosed OA of knee joint had a positive family

history and were post menopausal.

Many similar studies have been carried out with respect to this problem.

Research should be done and implemented in planning proper interventions and

control of obesity as a risk factor of osteoarthritis of knee. Moreover research

should also be done on the control of disease progression.

CONCLUSIONS:

The study concludes that:

Obesity is strongly associated with the development of secon dary OA of

knee in both pre and post menopausal females.

Chances of development of bilateral knee osteoarthritis are the maximum,

followed by right unilateral disease.

Being overweight increases the risk of developing KOA.

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Family history and menopause don’ t have a strong association with

secondary KOA.

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REFERENCES

1. Altman, R., et al. (1986) Development of criteria for the classification and

reporting of osteoarthritis. Classification of osteoarthri tis of the knee.

Diagnostic and Therapeutic Criteria Committee of the American Rheumatism

Association. Arthritis Rheum ; 29: 1039-49

2. Kafil, N., Aamir, K., Murad, S., Ara, J ., Anjum, S. (2003) A placebo controlled

clinical trial on Nimesulide in Osteoarthritis J Surg Pakistan Jun; 8: 5-8. (2).

3. Davis, M.A., Neuhaus, J .M., Ettinger, WH., Muller, W.H. (1990) Body fat

distribution and osteoarthritis . American Journal of Epidemiology ; 132:701-707.

4. Mehrotra, C., Naimi,T.S., Serdula, M., Bolen, J ., Pearson, K. (2004) Arthritis,

body mass index, and professional advice to lose weight: implications for

clinical medicine and public health. Am J Prev Med .; 27:16-21.

5. Acheson, R.M., Collart, A.B. (1975) New Haven survey of joint diseases.

Relationship between some systemic characteristics and osteoarthrosis in a

general population. Ann Rheum Dis ; 34:379–387.

6. Andriacchi, T.P. (1994) Dynamics of knee malalignment. Clin Orthop North Am ;

25(3):395-403.

7. Creamer, P. , Lethbridge-Cejku, M., Hochberg, M.C., (2000) Factors associated

with functional impairment in symptomatic knee osteoarthritis. Rheumatol

(Oxf); 39(5):490-496.

8. Jinks, C., Jordan, K., Croft, P. (2002) Measuring the population impact of knee

pain and disability with the Western Ontario and McMaster Universities.

Osteoarthritis Index (WOMAC). Pain ; 100(1-2):55-64.

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PERFORMA FOR DATA COLLECTION

1. Serial no.: 2.Date of assessment:

3. Name: 4.Age:

5. Address:

6. Contact no.: 7.Occupation:

7.Socioeconomic status: Upper Middle Lower

8. Height: m 9. Weight: kg

10. BMI: kgm-2

11. Menopause: Yes No

12. Family history of osteoarthritis: Yes No

13. Pain in knee joint? Yes No

14. Which knee is affected?

Right Left Bilateral None

15. Do your joints feel achy with activity and better with rest?

Yes No

16. H/O morning stiffness? Yes No

17. H/O radiating pain? Yes No

18. Joint swelling? Yes No

19. Crepitus? Yes No

20. Difficulty in climbing stairs? Yes No

21. Weak quadriceps? Yes No

22. Deformity in knee joint? Yes No

23. Antalgic gait? Yes No

24. Diagnostic result Yes No

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TABLES:

Descriptive measure of age, weight and height

Distribution of BMI

Frequency of diagnostic results

Mean ± SD

Age

53.2200 ± 6.70452

Height

1.6194 ± .09148

Weight

81.5800 ± 16.39075

Frequency Percentage

Yes 40 80%

No 10 20%

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Distribution of effected knee

Frequencies of variables in diseased subjects

Frequency Percentage

Right 17 42%

Left 4 10%

Bilateral 19 48%

Frequency

Percentage (%)

No Yes No Yes

Family history of osteoarthritis 16 24 40 60

Menopause 10 30 25 75

Pain in knee joint 0 40 0 100

Joints feel better with rest 0 40 0 100

History of morning stiffness 0 40 0 100

Joint swelling 0 40 0 100

History of radiating pain 11 29 28 72

Crepitation 0 40 0 100

Difficulty in climbing stairs 0 40 0 100

Weak quadriceps 2 38 5 95

Deformity in knee joint 28 12 70 30

Antalgic gait 14 26 35 65

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Association between Body Mass Index and Diagnostic Result

As the p value is less than 0.05, so it indicates that there is significant relationship BMI and knee

osteoarthritis

Association between Family History of Osteoarthritis and Diagnostic Result

P value is less than 0.05 but family history of osteoarthritis and diagnostic result show weak

association

BMI Diagnostic result Total

Yes No

Normal 3 5 8

Overweight 9 4 13

Obese 28 1 29

Total 40 10 50

Value Df

Asymp. Sig. (2-

sided)

Pearson Chi-Square 14.939 2 .001

Family history

of

osteoarthritis

Diagnostic result Total

No yes

No 8 16 24

Yes 2 24 26

Total 10 40 50

Value df

Asymp. Sig. (2-

sided)

Pearson Chi-Square 5.128a 1 .024

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Association between Menopause and Diagnostic Result

P value is less than 0.05 but menopause and diagnostic result show weak association.

Menopause Diagnostic result Total

No Yes

No 6 10 16

Yes 4 30 34

Total 10 40 50

Value df

Asymp. Sig. (2-

sided)

Pearson Chi-Square 4.504a 1 .034

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