Cultural practices and knee osteoarthritis in Central Asia: a case-control study on risk and protective factors

Knee osteoarthritis (KOA) is a degenerative joint disease that leads to pain, stiffness, and disability. While established risk factors such as age, obesity, and joint injury are well-documented, the role of cultural practices remains underexplored. This study investigates the association between traditional cultural practices and KOA prevalence in Central Asia.

A case-control study was conducted between January and March 2025 in Turkestan, Kazakhstan, involving 337 KOA cases and 685 matched controls. Participants completed structured questionnaires assessing demographic characteristics, lifestyle habits, and cultural practices. Unconditional logistic regression analyses identified associations between cultural factors and KOA, adjusting for age, sex, BMI, education level, physical workload, and type of residence.

Frequent floor sitting (OR = 4.25, 95% CI: 3.02-5.99), squat toilet use (OR = 2.32, 95% CI: 1.66-3.23), and rural residence (OR = 7.57, 95% CI: 4.99-11.48) were strongly associated with KOA. Daily prayer postures did not significantly differ between cases and controls.

Traditional cultural practices involving prolonged knee flexion were associated with KOA. Public health initiatives should consider culturally appropriate strategies that may help mitigate knee strain. Further longitudinal research is needed to establish causality.