Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis
- Allan C. Gelber, MD, MPH, PhD;
- Marc C. Hochberg, MD, MPH;
- Lucy A. Mead, ScM;
- Nae-Yuh Wang, MS, PhD;
- Fredrick M. Wigley, MD; and
- Michael J. Klag, MD, MPH
- From Johns Hopkins University, University of Maryland, and Veterans Affairs Medical Center, Baltimore, Maryland.
Abstract
Background: Knee and hip injuries have been linked with osteoarthritis in cross-sectional and case–control studies, but few prospective studies have examined the relation between injuries in young adults and risk for later osteoarthritis.
Objective: To prospectively examine the relation between joint injury and incident knee and hip osteoarthritis.
Design: Prospective cohort study.
Setting: Johns Hopkins Precursors Study.
Participants: 1321 former medical students.
Measurements: Injury status at cohort entry was recorded when the mean age of participants was 22 years. Injury during follow-up and incident osteoarthritis were determined by using self-administered questionnaires. Osteoarthritis was confirmed by symptoms and radiographic findings.
Results: Over a median follow-up of 36 years, 141 participants reported joint injuries (knee alone [n = 111], hip alone [n = 16], or knee and hip [n = 14]) and 96 developed osteoarthritis (knee alone [n = 64], hip alone [n = 27], or knee and hip [n = 5]). The cumulative incidence of knee osteoarthritis by 65 years of age was 13.9% in participants who had a knee injury during adolescence and young adulthood and 6.0% in those who did not (P = 0.0045) (relative risk, 2.95 [95% CI, 1.35 to 6.45]). Joint injury at cohort entry or during follow-up substantially increased the risk for subsequent osteoarthritis at that site (relative risk, 5.17 [CI, 3.07 to 8.71] and 3.50 [CI, 0.84 to 14.69] for knee and hip, respectively). Results were similar for persons with osteoarthritis confirmed by radiographs and symptoms.
Conclusions: Young adults with knee injuries are at considerably increased risk for osteoarthritis later in life and should be targeted in the primary prevention of osteoarthritis.
Article and Author Information
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Presented in part at the 60th National Scientific Meeting of the American College of Rheumatology, Orlando, Florida, 19–22 October 1996.
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Acknowledgment: The authors thank the members of the Precursors Study, whose dedicated participation over 47 years has made this work possible.
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Grant Support: In part by grants from the National Institutes of Health (AG-01760, KO8 AR-01939) and a Postdoctoral Fellowship award from the Arthritis Foundation.
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Requests for Single Reprints: Allan C. Gelber, MD, MPH, PhD, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205.
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Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
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Current Author Addresses: Dr. Gelber: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205.
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Dr. Hochberg: University of Maryland School of Medicine, 10 South Pine Street, MSTF 8-34, Baltimore, MD 21201.
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Ms. Mead and Dr. Wang: The Precursors Study, 2024 East Monument Street, Suite 2-200, Baltimore, MD 21205.
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Dr. Wigley: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7300, Baltimore, MD 21205.
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Dr. Klag: Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205.
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Author Contributions: Conception and design: A.C. Gelber, M.C. Hochberg, L.A. Mead, M.J. Klag.
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Analysis and interpretation of the data: A.C. Gelber, M.C. Hochberg, L.A. Mead, N. Wang, F.M. Wigley, M.J. Klag.
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Drafting of the article: A.C. Gelber, M.C. Hochberg, M.J. Klag.
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Critical revision of the article for important intellectual content: A.C. Gelber, M.C. Hochberg, L.A. Mead, N. Wang, F.M. Wigley, M.J. Klag.
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Final approval of the article: A.C. Gelber, M.C. Hochberg, L.A. Mead, N. Wang, F.M. Wigley, M.J. Klag.
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Provision of study materials or patients: L.A. Mead, M.J. Klag.
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Statistical expertise: L.A. Mead, N. Wang.
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Obtaining of funding: A.C. Gelber, M.J. Klag.
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Administrative, technical, or logistic support: M.J. Klag.
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Collection and assembly of data: A.C. Gelber, M.C. Hochberg, L.A. Mead, M.J. Klag.
- Copyright ©2004 by the American College of Physicians
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