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ObjectiveThe effect of physical activity on the risk of developing knee osteoarthritis (OA) is unclear. We undertook this study to examine the relationship between recreational physical activity and incident knee OA outcomes using comparable physical activity and OA definitions.MethodsData were acquired from 6 global, community-based cohorts of participants with and those without knee OA. Eligible participants had no evidence of knee OA or rheumatoid arthritis at baseline. Participants were followed up for 5-12 years for incident outcomes including the following: 1) radiographic knee OA (Kellgren-Lawrence [K/L] grade ≥2), 2) painful radiographic knee OA (radiographic OA with knee pain), and 3) OA-related knee pain. Self-reported recreational physical activity included sports and walking/cycling activities and was quantified at baseline as metabolic equivalents of task (METs) in days per week. Risk ratios (RRs) were calculated and pooled using individual participant data meta-analysis. Secondary analysis assessed the association between physical activity, defined as time (hours per week) spent in recreational physical activity and incident knee OA outcomes.ResultsBased on a total of 5,065 participants, pooled RR estimates for the association of MET days per week with painful radiographic OA (RR 1.02 [95% confidence interval (95% CI) 0.93-1.12]), radiographic OA (RR 1.00 [95% CI 0.94-1.07]), and OA-related knee pain (RR 1.00 [95% CI 0.96-1.04]) were not significant. Similarly, the analysis of hours per week spent in physical activity also showed no significant associations with all outcomes.ConclusionOur findings suggest that whole-body, physiologic energy expenditure during recreational activities and time spent in physical activity were not associated with incident knee OA outcomes.

ObjectivesTo examine whether foot and/or ankle pain increases the risk of knee OA.DesignWe utilised longitudinal data from the Multicentre Osteoarthritis Study (MOST); a community-based cohort of risk factors for knee OA. Participants without frequent knee pain (clinic visit only) and radiographic knee OA (RKOA) at baseline and, with no evidence of inflammatory musculoskeletal disease and a history of knee-related surgery were followed for up to 84-months for incident outcomes; i) RKOA (Kellgren-Lawrence (KL) ≥2), ii) symptomatic RKOA (RKOA and frequent pain in the same knee) and iii) frequent knee pain only. At baseline, ankle and foot symptoms were assessed, with knee radiographs and symptoms also assessed at 30, 60 and 84-months. Our exposures included baseline ankle, foot, and ankle and foot pain (participant-level). Associations between foot and/or ankle pain and incident outcomes were assessed using multiple logistic regression, with adjustment for participant characteristics and ankle/foot pain.ResultsNo statistically significant associations were observed between ankle, foot and, ankle and foot pain and incident RKOA, respectively. Ankle pain with (2.30, 95% CI 1.13 to 4.66) and without foot pain (OR: 2.53, 95% CI 1.34 to 4.80) were associated with increased odds of incident symptomatic RKOA and frequent knee pain. No statistically significant associations were observed between foot pain and these outcomes.ConclusionsAnkle pain should be a focus point, more so than foot pain, in the management of knee OA. Future studies should include additional ankle joint-specific symptom questions to better elucidate the knee OA biomechanical pathway.

BackgroundOsteoarthritis (OA) is a chronic joint disease, with increasing global burden of disability and healthcare utilisation. Recent meta-analyses have shown a range of effects of OA on mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering individual participant-level data (IPD) from international observational studies and standardising methods to determine the association of knee OA with mortality in the general population.MethodsSeven community-based cohorts were identified containing knee OA-related pain, radiographs, and time-to-mortality, six of which were available for analysis. A two-stage IPD meta-analysis framework was applied: (1) Cox proportional hazard models assessed time-to-mortality of participants with radiographic OA (ROA), OA-related pain (POA), and a combination of pain and ROA (PROA) against pain and ROA-free participants; (2) hazard ratios (HR) were then pooled using the Hartung-Knapp modification for random-effects meta-analysis.Findings10,723 participants in six cohorts from four countries were included in the analyses. Multivariable models (adjusting for age, sex, race, BMI, smoking, alcohol consumption, cardiovascular disease, and diabetes) showed a pooled HR, compared to pain and ROA-free participants, of 1.03 (0.83, 1.28) for ROA, 1.35 (1.12, 1.63) for POA, and 1.37 (1.22, 1.54) for PROA.DiscussionParticipants with POA or PROA had a 35-37% increased association with reduced time-to-mortality, independent of confounders. ROA showed no association with mortality, suggesting that OA-related knee pain may be driving the association with time-to-mortality.FundingVersus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.

ObjectiveWith adults working to older ages, occupation is an important, yet less modifiable domain of physical activity to consider in the risk of knee osteoarthritis (OA). This study aimed to investigate the association between predominant lifetime occupation and prevalent knee OA.DesignParticipant-level data were used from five international community-based cohorts: Johnston County Osteoarthritis Project, the Hertfordshire Cohort Study, the Multicenter Osteoarthritis Study, the Tasmanian Cohort Study and Framingham Osteoarthritis Study. Self-reported predominant occupation was categorized into sedentary, light, light manual and heavy manual levels. Cross-sectional associations between predominant lifetime occupation and knee OA outcomes including prevalence of radiographic knee OA (RKOA), symptomatic RKOA and knee pain, were assessed using logistic regression, accounting for cohort clustering.ResultsData for 7391 participants were included. 24.7% reported sedentary lifetime occupation, 30.0% light, 35.9% light manual and 9.4% heavy manual. 43.3% presented with RKOA, 52.1% with knee pain and 29.0% with symptomatic RKOA. There was over a two-fold increase in the odds of having RKOA, knee pain and symptomatic RKOA in those whose with heavy manual compared to sedentary occupations ((odds ratio (OR): 2.14; 95% confidence interval (CI): 1.79, 2.58), (OR: 2.19; 95% CI: 1.78, 2.70), (OR: 2.41; 95% CI: 1.94, 2.99) respectively).ConclusionThis large international multi-cohort study demonstrated an association of heavy manual work with RKOA, symptomatic RKOA and knee pain. Measures that protect workers and are designed to reduce heavy manual related activities remain a priority to reduce the risk of knee OA.

ObjectivesTo examine the effect of occupation on knee osteoarthritis (OA) and total knee replacement (TKR) in working-aged adults.MethodsWe used longitudinal data from the Chingford, Osteoarthritis Initiative (OAI) and Multicentre Osteoarthritis (MOST) studies. Participants with musculoskeletal disorders and/or a history of knee-related surgery were excluded. Participants were followed for up to 19-years (Chingford), 96-months (OAI) and 60-months (MOST) for incident outcomes including radiographic knee OA (RKOA), symptomatic RKOA and TKR. In those with baseline RKOA, progression was defined as the time from RKOA incidence to primary TKR. Occupational job categories and work-place physical activities were assigned to levels of workload. Logistic regression was used to examine the relationship between workload and incident outcomes with survival analyses used to assess progression (reference group: sedentary occupations).ResultsHeavy manual occupations were associated with a 2-fold increased risk (OR: 2.07, 95% CI 1.03 to 4.15) of incident RKOA in the OAI only. Men working in heavy manual occupations in MOST (2.7, 95% CI 1.17 to 6.26) and light manual occupations in OAI (2.00, 95% CI 1.09 to 3.68) had a 2-fold increased risk of incident RKOA. No association was observed among women. Increasing workload was associated with an increased risk of symptomatic RKOA in the OAI and MOST. Light work may be associated with a decreased risk of incident TKR and disease progression.ConclusionHeavy manual work carries an increased risk of incident knee OA; particularly among men. Workload may influence the occurrence of TKR and disease progression.

Introduction: The aim of this study was to examine the incidence and progression of foot osteoarthritis (OA), as well as associated factors, in a community-based cohort. Methods: Baseline (2013–2015) and follow-up (2016–2018) foot radiographs were available for 541 participants (71% women, mean age 69 years; 35% black, 53% with obesity). The LaTrobe Foot Atlas was used to examine osteophytes (OPs, score 0–3) and joint space narrowing (JSN, score 0–3) at 5 joint sites. Incident foot radiographic OA (rOA) was a baseline score <2 OP and JSN in all 5 joints with ≥2 OP or JSN at follow-up in any of the joints. Progression was a worsening OP or JSN score in a joint with baseline foot rOA. At baseline and follow-up, participants reported the presence/absence of foot symptoms and completed the Foot and Ankle Outcome Score (FAOS) for each foot. Joint-based logistic regression models with generalized estimating equations were used to examine associations (adjusted odds ratio [aOR], 95% confidence interval [CI]) of foot rOA incidence and progression and with covariates. Results: Among 928 feet without baseline rOA, 4% developed incident foot rOA (2% of those developed symptoms). Among 154 feet with baseline foot rOA, 55% had radiographic progression (16% of those had symptoms). Women and those with higher body mass index (BMI) were more likely to have incident foot rOA (aOR [95% CI] = 4.10 [1.22, 13.8] and 1.60 [1.31, 1.97], respectively); history of gout was associated with incidence or progression of foot rOA (2.75 [1.24, 6.07]). BMI was associated with worse scores on all FAOS subscales (aORs range 1.21–1.40). Conclusion: Progression of foot rOA is common but not necessarily related to worsening symptoms. BMI may be a modifiable risk factor for foot OA. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, there has been a growth in the use of ankle replacements. Data from national joint registries have shown between-country differences in the utilization of ankle replacement. The reasons for these differences are, however, not well understood. Our aims were to describe and compare the annual incidence of primary ankle replacement between countries and, to examine potential reasons for variation over time. Methods: We used aggregate data and summary statistics on ankle replacements for the period 1993 to 2019 from national joint replacement registries in Australia, Finland, New Zealand, Norway, Sweden and the United Kingdom. From the annual recorded counts of procedures, demographic data were extracted on age, sex distribution, and indication(s) for primary ankle replacement. Registry-level summary results were also obtained on data completeness, counts of hospitals/units, and health care providers performing ankle replacements annually and data collection processes (mandatory vs voluntary). Annual ankle replacement incidence for all diagnoses and, by indication categories (osteoarthritis [OA] and rheumatoid arthritis [RA]), were calculated per 100 000 residential population aged ≥18 years. Results: For the period with data from all 6 countries (2010-2015), New Zealand had the largest annual incidence (mean ± SD) of 3.3 ± 0.2 ankle replacement procedures per 100 000 population whereas Finland had the lowest incidence (0.92 replacements). There were no common temporal trends in the utilization of ankle replacements. Over the years studied, OA was the predominant diagnosis in the United Kingdom, Australia, and New Zealand, whereas RA was the most common indication in Scandinavia. Conclusion: In these 6 countries, we found marked differences in the utilization of ankle replacements. Registry-related factors including data completeness and the number of hospitals/surgeons performing ankle replacements are likely to contribute to the observed between-country differences and need to be carefully considered when interpreting comparisons for this less common site for joint replacement surgery. Level of Evidence: Level III, retrospective study. [ABSTRACT FROM AUTHOR]

Background: Ankle sprain is a very common injury, yet uncertainty exists in what is appropriate time to return to play (RTP). Such guidance may inform treatment pathways and effective practice. Objectives: To determine if consensus exist about potential influencing factors for time to RTP in conservatively treated ankle sprain. Methods: We searched AMED, CINAHL Plus, Cochrane library, EMBASE, MEDLINE (EBSCO), SPOERDiscus, PsycINFO, PEDro, Scopus, unpublished literature and ongoing trials and Google Scholar from inception until April 2017. The quality of the eligible papers was assessed using the Downs and Black tool for randomized controlled trials (RCTs) and Critical Appraisal Skills Program (CASP) for observational studies. Results: The initial search identified 1885 articles. After screening, 14 articles were included. Of these, 11 were RCTs and 3 were prospective observational studies. Individual treatment methods that resulted in a shorter time to RTP were functional treatment, compression stockings, anteroposterior joint mobilization, hyaluronic acid injection (HA), Jump Stretch Flex Band programme (JSFB) and diclofenac medication. Prognostic factors for determining time to RTP in the included prospective observational studies were measures of Global function, SF 36PF, athlete's ambulation status, weight-bearing activity scores and self-reported athletic ability. Conclusion: To our knowledge, this is the first review to report influencing factors for time to RTP following conservatively treated ankle sprain. Findings from this review identified factors that influence time to RTP. However, caution should be taken in generalizing these results due to the heterogeneity of studies and inability to clearly define and list the criteria for safe RTP. The inclusion of factors such as age, sex, BMI, level of sport, injury related factors in future studies might help to understand the course of injury and therefore assist in constructing safer criteria. [ABSTRACT FROM AUTHOR]

Objective To determine the prevalence and natural history of foot-related disability in patients with rheumatoid arthritis (RA). A secondary aim was to identify explanatory variables, including forefoot bursae, that are either associated with or predictive of disabling foot complications in patients with RA. Methods A longitudinal prospective cohort study recruited patients with RA from a rheumatology outpatient clinic. Data were collected at baseline (n = 149) and 1-year (n = 120) and 3-year followup (n = 60). Patient-reported disabling foot complications were evaluated using the subscales of the Foot Impairment Score (FIS): foot impairment/footwear restriction (FISIF) and activity limitation/participation restriction (FISAP). Explanatory variables investigated included ultrasound-detectable forefoot pathology and markers of disease activity. Results Disabling foot complications were highly prevalent on all occasions. Changes in foot impairment and activity limitation were significantly associated with fluctuations in disease activity (Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28-ESR]: r = 0.455, P < 0.0001; ESR: r = −0.356, P = 0.008 and DAS28-ESR: r = 0.433, P = 0.001; ESR: r = −0.439, P = 0.001 for the FISIF and FISAP, respectively), and approaching a significant association with changes in forefoot bursae (FISIF: r = 0.255, P = 0.063 and FISAP: r = 0.255, P = 0.063). The presence of disease duration and forefoot bursae was a significant prognostic indicator of foot impairment ( P = 0.009 and P = 0.012, respectively), explaining 16% of score variability in the final regression model. Disease duration, forefoot bursae, and erosion presence were identified as significant prognostic indicators of activity limitation ( P = 0.002, P = 0.006, and P = 0.019, respectively), explaining 35% of score variability in the final regression model. Conclusion Despite advances in disease management, patients report disability associated with foot problems. Forefoot bursae should be considered for targeted therapy. [ABSTRACT FROM AUTHOR]