Influence of physically demanding occupations on the development of osteoarthritis of the hip: a systematic review
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Susanne Unverzagt1, Ulrich Bolm-Audorff2, Thomas Frese3
1Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany. susanne.unverzagt@uk-halle.de.
Insights
Physically demanding jobs significantly increase the risk of developing hip osteoarthritis (HOA). Occupations in agriculture, construction, and those involving heavy manual labor or whole-body vibration pose the highest risks.
Area of Science:
- Occupational health
- Epidemiology
- Rheumatology
Background:
- Hip osteoarthritis (HOA) is a widespread disabling condition with significant societal costs.
- Working-age individuals and the elderly are particularly susceptible to HOA.
- Physically demanding occupations represent a key risk factor for HOA development.
Purpose of the Study:
- To systematically review and evaluate the influence of physically demanding occupations on the development of HOA in men.
- To identify specific occupational groups and physical demands associated with increased HOA risk.
Main Methods:
- A systematic review of cohort, case-control, and cross-sectional studies published in English or German from 1990 to May 2020.
- Searches were conducted in major electronic databases and conference abstracts.
- Methodological quality was assessed, and relative risks (RRs) were meta-analytically reviewed.
Main Results:
- Six physically demanding occupational groups demonstrated an elevated risk of developing HOA.
- Agriculture, fishery, forestry, and food production doubled HOA risk.
- Construction, metal working, sales, and driving with whole-body vibration increased risk by 50-60%; unskilled manual labor nearly doubled risk (RR 1.89).
Conclusions:
- A clear association exists between high physical workload occupations and increased HOA risk.
- Key risk factors include heavy lifting, demanding postures, repetitive tasks, prolonged standing, and whole-body vibration.
- Occupational prevention, early detection, and health promotion should target high physical strain in the workplace.
Background:
Hip osteoarthritis (HOA) is a disabling disease affecting around 33 million people worldwide. People of working age and the elderly are at increased risk of developing HOA and the disease is associated with high costs at individual and societal levels due to sick leaves, job loss, total hip replacements and disability pension. This systematic review evaluated the influence of physically demanding occupations on the development of HOA in men.
Methods:
Cohort studies, case-control studies and cross-sectional studies with publications in English or German, which assessed the association between exposure to physically demanding occupations and development of HOA, were searched in electronic databases (Medline, Embase, HSE-Line, Cochrane Library) and conference abstracts from 1990 until May 2020. We assessed the methodological quality of selected studies, interpreted all relative effect estimators as relative risks (RRs) and meta-analytically reviewed the effects of occupations with high physical workloads. All steps are based on a study protocol published in PROSPERO (CRD42015016894).
Results:
Seven cohort studies and six case-control studies were included. An elevated risk to develop HOA was shown for six physically demanding occupational groups. Working in agriculture including fishery and forestry and food production doubles the risk of HOA. Construction, metal working and sales as well as exposure to whole body vibration while driving vehicles increases the risk by roughly 50 to 60%. Unskilled or basic level workers, who were frequently exposed to repetitive heavy manual work, had nearly a doubled risk (RR 1.89 95%CI: 1.29 to 2.77) compared to workers with lower exposure.
Conclusions:
Existing studies state an association between various occupations with high physical workload and an increased risk of developing HOA. High Physical workloads include including lifting and carrying heavy loads, demanding postures, repetitive activities, long standing and running, as well as exposure to body vibrations. Occupational prevention and early detection as well as individual health promotion strategies should place their focus on reducing the impact of high physical strain at work sites.
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