Risk factors for development of lower limb osteoarthritis in physically demanding occupations: A systematic review and meta-analysis

Appl Ergon. 2020 Jul;86:103097. doi: 10.1016/j.apergo.2020.103097. Epub 2020 Apr 17.


This systematic review and meta-analysis identified and critically reviewed the findings of recent studies (last 15 years) examining relationships between specific physically demanding occupations or occupational tasks and development of lower limb osteoarthritis (OA). Twenty-eight studies with 266,227 cases of lower limb OA were included. Occupational tasks contributing to OA included farming, floor laying, and brick laying. Activities significantly contributing to the risk of knee OA were lifting heavy loads (>10 kg/week) (odds ratio [OR] = 1.52, 95% confidence interval [95%CI] 1.29-1.79), squatting/kneeling (OR = 1.69, 95%CI 1.15-2.49), standing (>2 h/daily) (OR = 1.22 95%CI 1.02-1.46) and walking (OR = 1.40 95%CI 1.14-1.73). Lifting contributed significantly to the risk of hip OA (OR = 1.35, 95%CI 1.16-1.57). The effects of occupational exposures appear to be magnified by previous injury and BMI >25 kg/m2. Since specific occupational activities increase OA risk, ergonomist should encourage the use of existing tools, or oversee the design of new tools that may decrease exposure to such activities.

Keywords: Lower limb; Occupational task; Occupations; Osteoarthritis; Risk factors.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Body Mass Index
  • Female
  • Humans
  • Lifting / adverse effects
  • Lower Extremity / physiopathology
  • Male
  • Middle Aged
  • Occupational Diseases / etiology*
  • Occupational Exposure / adverse effects*
  • Occupations / statistics & numerical data*
  • Odds Ratio
  • Osteoarthritis, Knee / etiology*
  • Risk Factors
  • Weight-Bearing / physiology
  • Work / physiology*
  • Workload