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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
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Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(5):321-328. doi:10.7326/0003-4819-133-5-200009050-00007
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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.

Figures

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Figure.
Cumulative incidence of knee osteoarthritis according to injury status at cohort entry.

Kaplan–Meier plots are shown for participants with joint injury ( ) and those without joint injury ( ) at cohort entry. = 0.0045 (log-rank test).

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Summary for Patients

Osteoarthritis of the Knee and Hip after Joint Injury

Copyright ©2004 by the American College of Physicians

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