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a Department
of Occupational Health, Karolinska Hospital, SE-171 76 Stockholm,
Sweden, b Department of Public Health Sciences, Division
of Occupational Health, Karolinska Institute, Stockholm, Sweden, c Department for Work and Health, National
Institute for Working Life, Solna, Sweden, d Department
of Orthopaedics, Lund University Hospital, Lund, Sweden
Correspondence to: Dr H Sandmark.
Accepted for publication 23 December 1998
OBJECTIVES
The aim was
to examine the relation between osteoarthrosis of the knee leading to
prosthetic surgery among men and women and overweight, smoking, and
hormone therapy.
METHODSA
case-referent study was performed with a study base of all men and
women, born 1921-1938, living in 14 counties in Sweden during
1991-95. The cases (n=625) were identified through the Swedish Knee
Arthroplasty Register. The referents (n=548) were randomly selected
through the central population register from the same counties.
Detailed information on general health status, height, weight, smoking
habits, medication, use of hormones, specific physical loads from
occupation and housework, and sports activities was collected by a
telephone interview and a postal questionnaire. The cases were
classified in terms of high, medium or low/non-exposure to the factors
studied, according to the distribution of variables among the referents.
RESULTSWomen with
high body mass index (BMI) at the age of 40 had a relative risk of 9.2 (95%CI 5.3, 16.0) of developing severe knee osteoarthrosis later in
life, and for men at the same age the relative risk was 3.9 (95%CI
2.3, 6.4). Smokers were less likely to develop severe knee
osteoarthrosis compared with non-smokers. Oestrogen therapy for women
over 50 showed an increased relative risk of 1.8 (95%CI 1.2, 2.6),
while use of oral contraceptives did not influence the risk .
CONCLUSIONOverweight
is a risk factor for knee osteoarthrosis leading to prosthetic surgery
in men and women, with the strongest relation for women. Oestrogen
therapy after 50 increased the relative risk, while smoking decreased it.
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