Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis

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

Presented in part at the 60th National Scientific Meeting of the American College of Rheumatology, Orlando, Florida, 19–22 October 1996.
Acknowledgment: The authors thank the members of the Precursors Study, whose dedicated participation over 47 years has made this work possible.
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.
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.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Dr. Gelber: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205.
Dr. Hochberg: University of Maryland School of Medicine, 10 South Pine Street, MSTF 8-34, Baltimore, MD 21201.
Ms. Mead and Dr. Wang: The Precursors Study, 2024 East Monument Street, Suite 2-200, Baltimore, MD 21205.
Dr. Wigley: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7300, Baltimore, MD 21205.
Dr. Klag: Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205.
Author Contributions: Conception and design: A.C. Gelber, M.C. Hochberg, L.A. Mead, M.J. Klag.
Analysis and interpretation of the data: A.C. Gelber, M.C. Hochberg, L.A. Mead, N. Wang, F.M. Wigley, M.J. Klag.
Drafting of the article: A.C. Gelber, M.C. Hochberg, M.J. Klag.
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.
Final approval of the article: A.C. Gelber, M.C. Hochberg, L.A. Mead, N. Wang, F.M. Wigley, M.J. Klag.
Provision of study materials or patients: L.A. Mead, M.J. Klag.
Statistical expertise: L.A. Mead, N. Wang.
Obtaining of funding: A.C. Gelber, M.J. Klag.
Administrative, technical, or logistic support: M.J. Klag.
Collection and assembly of data: A.C. Gelber, M.C. Hochberg, L.A. Mead, M.J. Klag.