Prevalence of Knee Osteoarthritis in India: A Systematic Review and Meta-Analysis of Population-Based Studies

India, the world's second most populous country, is witnessing a rapid increase in its elderly population, obesity rates, and urbanization. A large portion of the population resides in resource-scarce rural areas or underprivileged urban slums, often employed in unskilled and labour-intensive sectors. These shifts in demographics and the country's diverse geographic landscape present unique challenges to joint health. Osteoarthritis, particularly in the knee, is a significant cause of pain and disability. However, in India, electronic data collection system regarding rheumatological diseases or chronic pain has yet to be developed.

In this context, a systematic review and meta-analysis were conducted to determine the overall prevalence of knee Osteoarthritis in India.

Up until December 2023, Databases like PubMed, Ovid, Scopus, manual references and Google search were searched. Data regarding Authors, year of publication, methodology, sample size, age & sex, osteoarthritis diagnostic criteria, study location, setting, sampling procedure, and overall prevalence rate, risk factors were all extracted. Risk of bias was assesses using the Joanna Briggs Institute critical assessment tool for analytical cross-section research. A meta-analysis of the random effect proportion was performed to account for potential heterogeneity among observational studies. The I2 value determined heterogeneity, and the funnel plot was used to illustrate publication bias.

A total of 717 articles were identified, including 127 from PubMed, 467 from Scopus, 17 from Ovid, and 106 via additional searches. Finally, 16 studies in total were included for the review. All of the included studies were prospective cross-sectional community-based surveys in urban, rural or mixed settings across India. A prevalence rate of 20.24%, with a 95% confidence interval of 11.90 to 30.13 was calculated for sixteen moderate quality heterogeneous studies with a publication bias. Compared to mixed rural-urban population (22.38, 95% CI 5.32-46.70) and rural populations (21.25, 95% CI 7.60-40.39), the urban prevalence (15.42, 95% CI 0.46-45.23) is marginally lower (p > 0.05). The most prevalent risk factors are advancing age, female gender, lower socioeconomic strata, lesser education, previous knee injury.

Variations in the prevalence of knee osteoarthritis have been noted in previous studies, likely due to differences in study designs, case definition, diagnostic approaches, the intricate interaction of various risk factors, and the diverse occupational stresses on joints. Moreover, the lack of electronic databases in developing nations may also play a role in this variability. To mitigate the burden of disability and sufferings, a comprehensive preventive health strategy and a cadre of well-trained healthcare professionals are essential.

The online version contains supplementary material available at 10.1007/s43465-025-01520-4.