What Jobs Are Toughest on the Knees?

What Jobs Are Toughest on the Knees?

Joint replacements for knee osteoarthritis are becoming more common, and now researchers have identified jobs that may lead to one.

Based on a review of 71 studies that included nearly one million workers, the riskiest occupations include agriculture, construction, mining, service jobs and housekeeping. And jobs that demand excessive kneeling, squatting, standing, lifting and climbing stairs all increase your odds.

A team of researchers from the University of Sydney in Australia, and the Universities of Oxford and Southampton in the United Kingdom found that:

  • Carpenters, bricklayers and floor installers have roughly three times the risk for knee osteoarthritis, compared with sedentary workers.
  • Farm workers have 64% higher odds for the condition, slightly higher than the 63% for builders and construction workers.
  • Housekeeping also carries a risk — with unpaid houseworkers facing up to 93% increased odds for knee osteoarthritis.
  • Some jobs were kinder to the knees, however. Workers in commerce, forestry, fishing, machinists, plumbers, electricians, technicians and postal workers did not have a statistically significant risk for knee osteoarthritis, the study found.

“Knee osteoarthritis is a leading cause of loss of work and disability worldwide and can necessitate invasive surgery including total knee replacement, so preventing occupational hazards is critical,” senior study author Dr. David Hunter said in a news release from the University of Sydney, where he leads the Institute of Bone and Joint Research.

Osteoarthritis develops as cartilage deteriorates and bone comes into contact with bone, causing pain and swelling, and limiting function, which affects lifestyle. It can follow an injury, but most of the time the cause is unknown, according to a New York orthopedic surgeon.

“There is a genetic component, but there’s also a lifestyle component,” said Dr. Jeffrey Schildhorn of Lenox Hill Hospital in New York City, who reviewed the findings. One of the biggest risk factors is being overweight or obese.

“I’ve seen arthritis in every walk of life,” he said.

Osteoarthritis is a disease of aging, so it’s not surprising that more people are suffering from it and that the number of joint replacements is soaring, because people are living longer, Schildhorn said. But, he added, there is no miracle cure.

“The thing with arthritis that makes it difficult to deal with is that cartilage has no true regenerative ability,” he said, suggesting that the best way to prevent it is to eat well and watch your weight. Stretching and exercises like yoga will also help keep joints limber, Schildhorn added.

Treatment can include pain medications, and physical or behavioral therapy. But when these don’t work, a knee replacement may be in order.

“Osteoarthritis is mechanical wear and tear,” Schildhorn said. “Some people have more resilient cartilage than others.” If it is very soft and flaky, no treatment is going to work and it has nothing to do with a person’s lifestyle — or their job, he said.

But employers can help by providing physical therapy and teaching workers how to do their jobs with less stress on their knees, Schildhorn said.

The report was recently published in the journal Arthritis Care and Research.

More information

Learn more about knee osteoarthritis from the American Academy of Orthopaedic Surgeons.

SOURCES: Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; University of Sydney, news release, July 8, 2020; Arthritis Care and Research, July 8, 2020

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In Many Cases, Hip Replacement Also Eases Back Pain

In Many Cases, Hip Replacement Also Eases Back Pain

THURSDAY, July 9, 2020 (HealthDay News) — If you have a bad hip and lower back pain, a new study suggests that hip replacement surgery may solve both issues at once.

Researchers at the Hospital for Special Surgery in New York City focused on 500 patients who underwent hip replacement surgery and followed up with them one year after the operation.

Over 40% reported pain in their lower back prior to hip surgery. Of that group, 82% saw their back pain vanish after surgery.

It was “completely gone,” said study author Dr. Jonathan Vigdorchik, a hip and knee surgeon at the hospital.

He said that experts in his field have studied the connection between the hip and back for years.

A hip replacement is a surgical procedure to replace a worn-out or damaged hip joint with an artificial one. On average, it is a highly successful operation, with 95% of patients experiencing pain relief, according to the Hospital for Special Surgery.

“It’s an outstanding procedure,” said Dr. Craig Della Valle, a professor of orthopedic surgery at Rush University Medical Center in Chicago. “There are very few things in medicine that are close to hip replacement in terms of how good of a medical procedure it is.” He wasn’t part of the study.

But Vigdorchik added that patients who have undergone some types of spinal surgery before a hip replacement face five times the rate of complications compared to the general population — for which the complication rate is less than 1%.

This knowledge prompted him to dive deeper into the hip-back interplay.

“We noticed that there are certain conditions where a hip condition can actually put undue stress on the back,” Vigdorchik explained.

He and his fellow researchers wanted to find out how effective a hip replacement can be in eliminating low back pain, and determine which patients are more likely to benefit.

The patients whose low back pain resolved after the surgery were those with “flexible spines,” according to Vigdorchik. When a person’s spine is flexible, a stiff or poorly functioning hip can drive the spine to move more than usual, causing pain.

Those with normal flexibility in their spine were also highly likely to have their pain resolved.

“Those are the patients whose back pain went away completely after their hip replacement, because their back pain was probably caused by their hip not functioning properly to begin with,” said Vigdorchik.

But the back pain in patients with stiff spines did not go away. Patients with stiff spines already have serious arthritis of the spine, and replacing the hip is unlikely to relieve their pain.

But how can you know if your back pain could be resolved with a hip replacement?

It’s not easy to figure that out on your own, according to Vigdorchik. “It really relies on a good physical exam, and then good X-rays,” he said.

Before a patient undergoes a hip replacement, surgeons will typically take an X-ray of the patient lying down.

In this study, researchers took X-rays of their patients standing up and sitting down, both before and after the surgery.

These X-rays allowed them to see how the hip and spine moved in relation to each other, and assessed the flexibility of their spine, as the patient switched from a standing position to a seated position.

Vigdorchik encouraged other surgeons to utilize these X-rays to identify patients whose ailing backs may be relieved by a hip replacement.

He also advised surgeons in the field to “look beyond just the hip.”

“Anytime they’re looking at the hip, they should also look at the back, and anytime they’re looking at the knee, they should also look at the hip,” Vigdorchik said.

The existence of an interplay between the hip and back is well known to experts, but Della Valle said that this study showed how consistent it is.

He said the study gives surgeons in the field “some tools to try to predict which patients you can tell, ‘Yeah, your back pain will get better,’ and others, well, maybe it won’t.”

The study was published online recently during a virtual meeting of the American Academy of Orthopaedic Surgeons.

More information

There’s more about low back pain at the U.S. National Institutes of Health.

SOURCES: Jonathan Vigdorchik, M.D., orthopedic surgeon, hip and knee replacement, Hospital for Special Surgery, New York City; Craig Della Valle, M.D., professor, orthopedic surgery, Rush University Medical Center, Chicago; AAOS 2020 Virtual Education Experience, March 26, 2020, online

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Vigorous Exercise Safe for Those at Risk of Knee Arthritis

Vigorous Exercise Safe for Those at Risk of Knee Arthritis

TUESDAY, May 12, 2020 (HealthDay News) — People at high risk for knee arthritis don’t need to avoid jogging and other types of vigorous exercise, a new study suggests.

Some folks hold back on physical activity because they fear it will increase their chances of developing knee arthritis, so researchers from Northwestern University’s Feinberg School of Medicine in Chicago took a closer look.

“Our study findings convey a reassuring message that adults at high risk for knee [arthritis] may safely engage in long-term strenuous physical activity at a moderate level to improve their general health and well-being,” said study author Alison Chang, associate professor of physical therapy and human movement sciences.

The study included nearly 1,200 people from several U.S. cities, ages 45-79, who were at high risk for knee arthritis but had no evidence of the condition.

Obesity, previous joint injury, surgery, aging and chronic knee symptoms increase the risk of developing arthritis of the knee.

Participants were followed for up to 10 years. Chang and her colleagues found that long-term participation in strenuous physical activities such as jogging, swimming, cycling, singles tennis, aerobic dance and skiing was not associated with risk of developing knee arthritis.

In fact, those who did vigorous exercise had a 30% lower risk of knee arthritis, but that’s not considered statistically significant, according to the authors.

Lots of sitting wasn’t associated with either an increased or reduced risk of arthritis.

“People suffering from knee injuries or who had arthroscopic surgical repair of ACL or meniscus are often warned that they are well on the path to develop knee [arthritis],” Chang said in a university news release.

“They may be concerned that participating in vigorous activities or exercises could cause pain and further tissue damage. To mitigate this perceived risk, some have cut down on or discontinued strenuous physical activities, although these activities are beneficial to physical and mental health,” she said.

The bottom line? “Health care providers may consider incorporating physical activity counseling as part of the standard care for high-risk individuals at an early stage when physical activity engagement is more attainable,” Chang said.

The study findings were published May 4 in the journal JAMA Network Open.

More information

The American Academy of Family Physicians has more on arthritis.

SOURCE: Northwestern University, news release, May 4, 2020

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How to Manage Your Osteoarthritis

How to Manage Your Osteoarthritis

(HealthDay News) — Osteoarthritis is the most common form of arthritis, affecting about 31 million Americans, and is the leading cause of disability among adults.

Known as OA, it causes pain and other symptoms in joints, which can affect the ability to do everyday tasks. There’s no known cure, but there are treatments that can relieve pain and maintain joint function, according to a rheumatologist at Wake Forest Baptist Health in Winston-Salem, N.C.

“Osteoarthritis is the thinning or wearing down of cartilage, which is the cushion between the separate bones in a joint,” Dr. Francis Luk said in a health system news release. “When your doctor says you have arthritis, most often they are referring to osteoarthritis.”

The main risk factors are aging, obesity, prior injury, repetitive stress on a joint and genetics. OA can occur in any joint, but the most common are knees, hips and hands.

“Symptoms vary from person to person but someone with osteoarthritis of the knee typically will have pain when they stand up from a seated position or when they’re walking, especially when going up and down stairs,” Luk said.

“With osteoarthritis of the hands, people typically experience pain when they do things that involve gripping — washing dishes, holding a wrench, opening a jar, things like that,” he added.

Treatments include over-the-counter drugs such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Aleve).

Other nonprescription options include topical creams and gels, such as those containing trolamine salicylate (Aspercreme), and the use of heating pads and ice packs.

Assistive devices such as canes, shoe orthotics, jar openers and tools with thicker handles can help with routine tasks.

For more advanced cases of OA, there are prescription pills and creams and steroid injections. The last resort is joint replacement surgery, especially of knees and hips.

“We always try to delay turning to surgery for as long as we can,” Luk said. “However, if you get to a point where you can’t walk from your living room chair to the bedroom, it would be a good idea to see an orthopedic surgeon.”

And, remember, two of the best ways to combat OA are maintaining a normal weight and getting regular exercise, he said.

“I tell people to do as much as they can tolerate until they have some pain and then rest,” Luk said. “I never recommend completely stopping activities, because the downside of inactivity is worse than osteoarthritis.”

More information

The American Academy of Family Physicians has more on osteoarthritis.

SOURCE: Wake Forest Baptist Health System, news release, Oct. 10, 2019

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Get Moving: Exercise Can Help Lower Older Women’s Fracture Risk

Get Moving: Exercise Can Help Lower Older Women’s Fracture Risk

FRIDAY, Oct. 25, 2019 (HealthDay News) — Older women who get even light exercise, like a daily walk, may lower their risk of suffering a broken hip, a large study suggests.

A number of studies have linked regular exercise to a lower risk of hip fracture — a potentially disabling or even fatal injury for older adults. Each year, more than 300,000 people in the United States aged 65 or older are hospitalized for a broken hip, according to the U.S. Centers for Disease Control and Prevention.

The new study, of more than 77,000 older U.S. women, took a deeper look at the types of exercise that are related to the risk of hip fracture and other bone breaks.

The researchers found that, on average, women who regularly exercised at any intensity — from walking, to doing yard work, to jogging — had a lower risk of hip fracture over 14 years, compared to inactive women.

It all suggests that even light activity is enough to curb the risk of these serious injuries, said study leader Michael LaMonte, a research associate professor at the State University of New York at Buffalo.

“We were happy to see a strong relationship between walking and lower hip fracture risk,” he said. “As we get older, we naturally do less-strenuous physical activity. This suggests that to lower your risk of hip fracture, you don’t need to do anything fancy. It can be as simple as walking.”

The findings “strongly support” longstanding recommendations for people to fit physical activity into their daily routine, according to Dr. Richard Bockman.

“Get out there and walk,” said Bockman, chief of the endocrine service at the Hospital for Special Surgery, in New York City.

Lower-impact activities do not have a big effect on bone density. But Bockman, who was not involved in the study, said that while bone density matters in hip fracture risk, other factors are also involved. They include muscle strength in the lower body, balance and agility, since broken hips are almost always the result of a fall.

The findings, published online Oct. 25 in JAMA Network Open, come from the Women’s Health Initiative — a study begun in the 1990s at 40 U.S. medical centers. It involved more than 77,000 women who were between the ages of 50 and 79 when they enrolled.

At the outset, the women reported on their usual physical activities, among other lifestyle factors.

Over an average of 14 years, one-third of the women suffered a bone fracture. When it came to hip fractures, women who’d reported higher amounts of physical activity at the study’s start typically had a lower risk.

For example, women who regularly got moderate to vigorous exercise, such as brisk walking or jogging, had a 12% lower risk of hip fracture than those who were less active. But there was also a link between “mild activity” — like slow dancing, bowling or golfing — and lower hip fracture risk. And the more often women walked, at any speed, the lower their risk of a broken hip.

The news wasn’t all good: Women who exercised at moderate to vigorous intensities had a relatively higher risk of a wrist or forearm fracture, compared to less-active women.

It’s not clear why, but LaMonte offered a guess: When women with more “functional ability” do fall, they may be more likely to stretch out an arm to break the fall, which is how wrist and forearm fractures often happen.

One question the study cannot address, LaMonte said, is whether starting exercise at an older age reduces hip fracture risk. Study participants who were physically active may have been active their whole lives.

But, he said, it is clear that “sitting less and moving more” is key in older adults’ overall health, with benefits such as better control of blood pressure and diabetes, and a lower risk of heart disease.

Besides exercise, older adults can take other steps to reduce their hip fracture risk, LaMonte noted. They include getting bone mass measurements as recommended by your doctor, and following a healthy diet with adequate amounts of calcium and vitamin D.

More information

The American Academy of Orthopaedic Surgeons has more on hip fracture prevention.

SOURCES: Michael LaMonte, Ph.D., M.P.H., research associate professor of epidemiology and environmental health, State University of New York at Buffalo; Richard Bockman, M.D., Ph.D., chief of endocrine service, Hospital for Special Surgery, and professor of medicine, Weill Cornell Medical College, New York City; Oct. 25, 2019, JAMA Network Open, online

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Your Noisy Knees May Be Trying to Tell You Something

Your Noisy Knees May Be Trying to Tell You Something

THURSDAY, Oct. 17, 2019 (HealthDay News) — Ever hear your joints clicking, creaking or crunching? Now, researchers say a new technique that listens closely to knees may help doctors diagnose and monitor osteoarthritis.

In the new study, researchers attached small microphones to participants’ knees, which allowed them to listen for high-frequency sounds as the person repeatedly stood up and sat down again.

Computer analysis of the sounds then provided information about the health of the knee, the study authors explained.

This study is the first to assess this technique in a large number of people with knee osteoarthritis. It was found to distinguish between healthy knees and those afflicted by this “wear-and-tear” form of arthritis.

The findings move the technique a step closer to use by doctors and in research, according to the report published Oct. 16 in the journal PLOS ONE.

“This work is very exciting because it involves scientists and clinicians working together as a team to develop an entirely new approach,” said project leader John Goodacre. He’s an emeritus professor at Lancaster University, in the United Kingdom.

“Potentially, this could transform ways in which knee osteoarthritis is managed. It will enable better diagnosis, and will enable treatments to be tailored more precisely according to individual knee condition. It will also enable faster, bigger and better clinical trials of new treatments,” Goodacre said in a university news release.

The next step for researchers is to develop a non-invasive portable device that health care providers could use to assess whether patients’ knees are changing or are responding to treatment for osteoarthritis.

This technique could provide a quicker, cheaper, more convenient and more accurate assessment than current methods, the study authors said.

More information

The American Academy of Family Physicians has more on osteoarthritis.

SOURCE: Lancaster University, news release, Oct. 16, 2019

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