Former Male Elite Athletes Have a Higher Prevalence of Osteoarthritis and Arthroplasty in the Hip and Knee Than Expected.
Tveit M, Rosengren BR, Nilsson JK, Karlsson MK. Am J Sports Med. 2011 Nov 30. [Epub ahead of print]
Over the past year, SMR has summarized studies that suggest a history of knee injury/surgery may increase the risk of knee osteoarthritis (OA) while walking and physical activity may help to reduce the risk of knee OA (see Related Posts below). There is debate about whether elite athletes, who may be exposed to injuries and very high repetitive loading, are at greater risk for knee OA. Therefore, Tveit et al evaluated whether former 678 male elite athletes (internationally or nationally ranked) in both impact (n = 586) and nonimpact (n = 92) sports have a higher prevalence (frequency) of hip and knee OA than 1316 male controls. A secondary goal was to explore what influence a significant soft-tissue knee injury has in the development of hip or knee OA. A survey asking about physician-diagnosed hip or knee OA, as well as knee or hip total joint replacements was mailed to 709 retired athletes (time since retirement ~ 35 years; range 1 to 63 years; age ~ 70 years, range = 50 to 93 years). For every athlete, the investigators contacted two male control participants identified in a national population registry that had similar date of births to an athlete. The initial response rates were 74% for the former athletes and 64% for the controls (they then sought additional controls to maintain a 2:1 ratio of matched controls to athletes). Unadjusted data indicated that former athletes had greater prevalence of hip OA, total hip replacements, soft tissue knee injuries, and knee OA compared to controls (knee replacements were not significantly different between groups). After adjusting for age, body mass index, occupation, and knee injury the authors found that former athletes were at greater risk for hip OA, total hip replacements but not knee OA or total knee replacements. When the athletes were broken down into impact (soccer, handball, ice hockey) and nonimpact sports (canoeing, long-distance running, weight lifting, gymnastics, swimming, cycling) it was the athletes with a history of impact sports that were at increased risk for hip OA or total hip replacement. It is interesting to note that athletes with a history of impact sports were at an increased risk for knee OA until knee injuries were controlled for; this suggest that among these athletes knee injuries may be modifying their risk of developing knee OA. Elite athletes with a history of nonimpact sports were at an increased risk for knee OA but not total knee replacement or hip OA.
This study offers some very interesting findings that further support the hypothesis that knee and hip OA may have different pathways to development. A higher risk of hip OA was predominantly related to athletes with a history of impact sports while the higher risk of knee OA was common among athletes with a history of impact and nonimpact sports. Furthermore, the risk of knee OA in athletes with a history of impact sports was associated with previous soft tissue knee injuries; interestingly, this was not the case among those with a history of nonimpact sports. It is important to note that the nonimpact sports among the elite athletes included some sports with very high repetitive loading (long-distance running) or very high loads with low repetition (weight lifting) which may influence how they influence the risk of joint degeneration. This study indirectly supports the potential benefits of injury prevention programs in impact sports. If we can reduce the risk of knee injury then we may be able to reduce the incidence of knee OA among impact sports. It should be noted that this study was performed among elite male athletes that may have competed in sports over 60 years ago, as well as controls with a history of military service (another risk factor for OA). This athletic population is distinct from college and high school athletes. Furthermore, these athletes may have received a different level of medical care than today’s athletic population. It is important for us to gain a better understanding of the influence of specific sports, injuries, injury management (short-term and long-term), sex, cumulative exposure (e.g., years played at elite level), and age of starting a sport. These may be important variables that contribute to OA. What do you tell athletes or parents that are concerned about the long-term health of an athlete’s joint?
Written by: Jeffrey Driban
Reviewed by: Stephen Thomas
Tveit M, Rosengren BR, Nilsson JK, & Karlsson MK (2011). Former Male Elite Athletes Have a Higher Prevalence of Osteoarthritis and Arthroplasty in the Hip and Knee Than Expected. The American Journal of Sports Medicine PMID: 22130474