title: Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review.
abstract: METHODS
  Systematic review with meta-analysis.
  
  
  OBJECTIVE
  To identify risk factors for osteoarthritis (OA) of the knee, hip, and ankle, including joint injury, sport, physical activity, overweight/obesity, and occupational activity, in all age groups.
  
  
  BACKGROUND
  OA is a significant health problem worldwide, affecting up to 10% of men and 18% of women over 60 years of age. There has not been a comprehensive review examining modifiable physical risk factors associated with the onset of OA. This evidence is important to inform the physiotherapy management of individuals following onset of OA.
  
  
  METHODS
  Twelve electronic databases were systematically reviewed. The studies selected met the following criteria: (1) original data; (2) joint injury, sport activity, physical activity, overweight/obesity, and/or occupational activity investigated as risk factors; (3) outcomes included OA (hip, knee, and/or ankle); and (4) analytic component of study design. The data extracted included study design, years of follow-up, study population, OA definition, risk factors, and results (effect estimates reported or calculated where available). The quality of evidence was assessed based on a modified version of the Downs and Black checklist.
  
  
  RESULTS
  Joint injury, obesity, and occupational activity were associated with an increased risk of OA of the knee and hip. Sport and physical activity produced inconsistent findings. Joint injury was identified as a significant risk factor for knee OA (combined odds ratio = 3.8; 95% confidence interval: 2.0, 7.2) and hip OA (combined odds ratio = 5.0; 95% confidence interval: 1.4, 18.2), as was previous meniscectomy with or without anterior cruciate ligament injury for knee OA (combined odds ratio = 7.4; 95% confidence interval: 4.0, 13.7). There is a paucity of research examining risk factors associated with ankle OA; this review identified only 2 studies with this outcome.
  
  
  CONCLUSIONS
  Joint injury, obesity, and occupational activity are associated with an increased risk of knee and hip OA. Some findings remain inconclusive, including levels of physical activity and sport specificity in individuals who do not suffer an injury. Early identification of individuals at risk for OA provides an opportunity for physiotherapy management or other interventions to modify risk-related behavior. There is a need in the literature for additional high-quality studies, such as prospective cohort studies, that minimize potential bias in examining the relationship between physical risk factors and OA.
  
  
  METHODS
  Prognosis, level 2a-.
authors.affiliation: Sport Injury Prevention Research Centre, Roger Jackson Centre for Health and Wellness Research, Faculty of Kinesiology, University of Calgary, Calgary, Canada. sarah.a.richmond@gmail.com
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Richmond
authors.forename: Reginaldo K
authors.initials: RK
authors.lastname: Fukuchi
authors.forename: Allison
authors.initials: A
authors.lastname: Ezzat
authors.forename: Kathryn
authors.initials: K
authors.lastname: Schneider
authors.forename: Geoff
authors.initials: G
authors.lastname: Schneider
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Emery
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries; D006801:Humans; D007596:Joints / Q000293:injuries; D035002:Lower Extremity / Q000293:injuries; D008592:Menisci, Tibial / Q000601:surgery; D009043:Motor Activity; D009765:Obesity; D009790:Occupations; D010003:Osteoarthritis / Q000209:etiology*; D012307:Risk Factors; D013177:Sports