Table 2 Osteoarthritis of the hip and heavy lifting
ReferenceStudy populationAge (years)Participation rateExposure measured by:Diagnostic criteriaAdjusted for/matched byComparisonsResults, OR (95% CI)DesignQuality of the study (+, ++, +++); strength/weakness
Typpö, 198524919 (416 males & 503 females) radiologically examined by veno-, angio-, uro-, colo-, or cystography, hips and abdomen16–86 (mean 57)Questionnaire Present occupation: mental (sic) light moderate heavyRetrospective radiological hip OA: mild, moderate, severeHeavy manual work vs no controls (mental (sic)/white collar workers)1.97 (1.14 to 3.41)Case-control+ Strength: none. Weakness: participation rate missing. No statistical testing. No adjustment for potential confounders. Data for only part of the study population (n = 505)
Jacobsson 19872085 males waiting for hip replacement, 262 males who have had urography70–76Questionnaire Job title classified as heavy/othersJoint-space <3 mm or waiting for THRAge, height, weightHeavy labour vs others2.2 (1.34 to 4.36)Case-control+ Strength: none. Weakness: participation rate not described. Results only sparsely described. No statistical analyses carried out
Heavy lifting vs others2.37 (1.32 to 4.28)
Vingaard 199125; Olsen 199422Cases: 233 males with hip replacement Controls: 302 randomly selected from general population50–7089%Telephone interview Occupational history for the last 20 years Questionnaire Lifting in all occupationsCases with THRAge, earlier diseases, sports activities, BMILifted tonsRelative riskCase-control+++ Strength: design and material well described. High number of participants. Interviews with specification of different physical activities. Inclusion of subjects having their first myocardial infarction as validation of the exposure measurement. Weakness: use of THR (risk of selection bias). Workload divided in light, medium, and heavy may be a risk of misclassification. Retrospective exposure information (risk of recall bias)
Medium exposure
<30 years1.73 (1.06 to 2.83)
>30 years1.63 (0.98 to 2.73)
High exposure
<30 years1.95 (1.23 to 3.09)
>30 years2.74 (1.70 to 4.43)
Number of lifts>40 kg
Medium exposure
<30 years1.73 (1.06 to 2.82)
>30 years1.60 (0.81 to 3.15)
High exposure
<30 years2.35 (1.47 to 3.74)
>30 years3.31 (1.97 to 5.57)
Vingaard 199127High exposure: Males: 116581 (914 OA) Females: 18434 (109 OA) Low exposure: Males: 91057 (320 OA) Females: 24145 (112 OA)Born 1905–45Register-basedOccupation Job title classified by occupational physicians Low/high exposureHospitalised in 1981–3 ICD-8 713.00 Hip OAAge, residenceHigh vs low exposureRelative riskCohort++ Strength: design and material well described. High number of participants. Weakness: Exposure classified by job title and in light, medium, heavy work (risk of misclassification). Case definition: “hospitalised because of hipOA” (risk of selection bias)
Born 1905–24
Males2.2 (1.6 to 2.8)
Females1.6 (0.9 to 3.1)
Born 1925–45
Males2.0 (1.6 to 2.3)
Females1.1 (0.9 to 1.5)
Vingaard 199226Cases: 140 males disability pension due to hip OA Controls: 298 males from the general populationBorn 1915–3473%Interview Occupational history Job title classified by experienced persons Low/medium/high exposurePrimary diagnosis made by a physician hip OAAgeHigh vs low exposureRelative riskCase-control++ Strength: description of material and design. Weakness: diagnosis (physician certificates, risk of misclassification). Subjects in heavy work may have increased risk of getting disability pension (risk of selection bias). Exposure: “high workload on hips” not especially related to heavy lifting (risk of misclassification)
Medium4.1 (2.4 to 7.1)
High12.4 (6.7 to 23.0)
Croft 199216Cases: 245 males with hip OA Controls: 294 males without hip OA examined by urography60–7568%Blinded interview Occupational history Specified physical activityJoint space All <2.5 mm Severe <1.5 mmAge, sport, BMILifting or moving weights >25.4 kg All JSN <2.5 mmCase-control+++ Strength: use of intravenous urograms may avoid selection bias. JSN defined. Results and analysis well described. Weakness: number of severe cases relatively small. Exposure measurement: “lift >25.4 kg”, frequency not further explained (risk of misclassification)
1–19 years0.9 (0.6 to 1.4)
⩾20 years1.2 (0.7 to 1.9)
Severe JSN <1.5 mm
1–19 years1.2 (0.5 to 2.9)
⩾20 years2.5 (1.1 to 5.7)
Roach 199423Cases: 99 with primary hip OA Controls: 233 with no radiographic hip OA examined by intravenous urographyAverage: 6877% (total 48%, chosen from a population of 693)Questionnaire Occupational history Classified in light, intermediate and heavy workKellgren & Lawrence grade 3–4 (joint space <1.5 mm)Obesity, age, sports activities, cancerIntermediate vs light work1.9 (1.0 to 3.8)Case-control++ Strength: JSN defined. Adjustment for obesity, age, sport. Weakness: high exclusion rate. Retrospective exposure measurement (risk of recall bias). Exposure divided in light or heavy work (risk of misclassification)
Heavy vs light work2.4 (1.3 to 4.3)
Vingaard 199728Cases: 273 females with THR in 4 areas of Sweden Controls: 273 females random sample from same areas50–7090%Interview Occupational history Specified physical activityTHRAge, BMI, sports activity, number of children, hormone therapyHeavy lifts vs lightRelative riskCase-control++ Strength: high participation rate. Occupational history by interview with specification of different physical activities. Adjustment for age, BMI, sports. Weakness: retrospective exposure data (risk of misclassification). Only number of heavy lifts (not further defined) reported
Medium1.1 (0.7 to 1.7)
High1.5 (0.9 to 2.5)
Coggon 199815Cases: 210 males 401 females waiting for surgery in three English districts Controls: 210 males, 401 females (random sample from general practices in the same area)45–91, mean: 7068%Interview Occupation held for >1 year from school age Specified physical activityCases waiting for surgeryBMI, hip injury, Heberden’s nodes. Matched by age and genderHeavy lifts at least 10 years 10 times/week vs no liftingCase-control+++ Strength: high number of participants. Well described study. Exposure collected by interviews with specification of different physical activities. Results adjusted. Weakness: participation rate 84% of cases, 58% of controls. Cases from a waiting list for THR (risk of selection bias). Retrospective exposure measurement (risk of recall bias). Few women in high exposure group
Lift >10 kg2.3 (1.2 to 4.2)
Lift >25 kg2.7 (1.4 to 5.1)
Lift >50 kg 13.2 (1.6 to 6.5)
FemalesNo significant differences
Cvitetic 199917590 (292 males 298 females) random sample from Zagreb city records 1981–3>45, mean: 63Questionnaire Occupation divided in 4 categories: mostly sedentary; mostly standing; no sitting; high physical strainClinical and radiological hip OA in right hip Kellgren & Lawrence grade 2–4Standing or lifting vs >80% sitting or standingCohort+ Strength: high number of participants. Weakness: participation rate not described. Results not controlled for confounders. Heavy lifting defined as lifts >5 kg (risk of misclassification)
Males1.5 (0.6 to 3.21)
Females1.45 (0.49 to 3.58)
Standing, walking, light work
Males1.16 (0.58 to 2.3)
Females1.19 (0.65 to 2.32)
Standing, walking, often heavy lifting >5 kg
Males1.15 (0.52 to 2.52)
Females1.34 (0.52 to 3.04)
Yoshimura 200029Cases: 103 females 11 males waiting for hip replacement in 2 districts in Japan Controls: 114 from the local population>45, mean: 6491%Questionnaire Occupation since leaving school; physical activity in their first and main jobWaiting for hip replacementAge, gender, residence matchedLift vs no liftCase-control+ Strength: same design as Coggon et al and Lau et al. Weakness: few participants, especially among males. Few women reported heavy lifting. Case definition (THR, risk of selection bias). Retrospective exposure data (risk of recall bias)
First job
Lifting >10 kg1.2 (0.6 to 2.4)
Lifting >25 kg3.5 (1.3 to 9.7)
Lifting >50 kg
Main job
Lifting >10 kg1.2 (0.6 to 2.1)
Lifting >25 kg1.5 (0.7 to 3.0)
Lifting >50 kg4.1 (1.1 to 15.2)
Lau 200021Cases: 30 males, 108 females hospitalised in Hong Kong with hip OA Controls: 90 males, 324 females from general practice over a 3-year period.Interview Physical activity in the job in which they had work for the longest period before symptomTHR (71%) Waiting for surgery (10%) Radiographic grade 3–4 OA (19%)Matched by gender and ageLift of 10 kg vs no liftCase-control++ Strength: same design as Coggon et al and Yoshimura et al. Weakness: only very few Chinese subjects with THR, especially in men. Case definition (THR, risk of selection bias). Retrospective exposure data (risk of recall bias)
1–10 times per week
Males1.9 (0.6 to 6.6)
Females0.7 (0.4 to 1.5)
>10 times per week
Males5.3 (1.8 to 15.8)
Females0.7 (0.4 to 1.5)
Lift of 50 kg vs no lift
1–10 times per week
Males8.5 (1.6 to 45.3)
Females2.9 (0.9 to 4.6)
>10 times per week
Males9.6 (2.2 to 42.2)
Females2.9 (1.5 to 5.6)
Flugsrud 200218278 males; 391 females from the Norwegian Arthroplastry Register 1989–98 24884 males, 24874 females from the Cardiovascular Screening Register 1981–3Mean: 5592%Questionnaire Graduated physical activity “during the last year” in sedentary; walking; walking and lifting; heavy manual labour Follow-up length 9 yearsTHRAge, height, marital status, smokingHeavy lifting vs sedentary workRelative riskCohort+++ Strength: large number of participants, high participation rate, prospective design. Weakness: Case definition (THR, risk of selection bias). Exposure measurement “physical activity during the 12 months” 1981–3 (risk of misclassification)
Males1.5 (1.0 to 2.2)
Females1.1 (0.8 to 1.6)
Males1.7 (1.1 to 2.4)
Females1.4 (0.9 to 2.0)
Males2.1 (1.5 to 3.0)
Females2.1 (1.3 to 3.3)
Jacobsen 2004191533 males 2618 females from Copenhagen City Heart Study Hip OA cases 105 males 167 females23–93 mean: 63–65– 41% of the initial cohort selected for radiographyQuestionnaire Physical activity since leaving school Mostly seated, standing/ walking, no lifting Lifting 1 ton Lifting 1–2 tons Lifting 2–5 tons Lifting >5 tonsStanding radiographs Case definition: JSN <2 mmAge, BMIMostly seated, standing, walking, no lifting Lifting 1 tons Lifting 1–2 tons Lifting 2–5 tons Lifting >5 tonsNo significant relations between type and duration of occupations (sedentary or involving repeated daily lifting OR 0.7–1.0Cohort++ Strength: high number of participants, prospective design, well described exposure measurements. Weakness: data and statistical analysis are not shown
  • THR, total hip replacement; SHR, standardised hospitalisation ratio; BMI, body mass index (weight/height2); OA, osteoarthritis.

  • + Poor quality score 1–5; ++ medium quality score 6–10; +++ high quality score >10.