Osteoarthritis (OA) is a disease of the entire joint involving the cartilage, joint lining,

ligaments, and underlying bone. The breakdown of these tissues eventually leads to pain and
joint stiffness. The joints most commonly affected are the knees, hips, and those in the hands
and spine. The specific causes of OA are unknown, but are believed to be a result of both
mechanical and molecular events in the affected joint. Disease onset is gradual and usually
begins after the age of 40. There is currently no cure for OA. Treatment for OA focuses on
relieving symptoms and improving function, and can include a combination of patient
education, physical therapy, weight control, use of medications, and eventually total joint
replacement.

I. Background

Also known as degenerative joint disease.

Most common form of arthritis.
Classified as: Idiopathic (localized or generalized) or Secondary (traumatic,
congenital, metabolic/endocrine/neuropathic and other medical causes).
Characterized by focal and progressive loss of the hyaline cartilage of joints,
underlying bony changes.
Usually defined by symptoms, pathology or combination 1
o Pathology = radiographic changes (joint space narrowing, osteophytes, and
bony sclerosis.)
o Symptoms = pain, swelling, and stiffness.
The American College of Rheumatology (ACR) has published clinical classification
guidelines for OA of the hand [PDF - 1.31MB] , hip [PDF - 1.31MB] , and
knee .

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II. Prevalence

Overall, in the United States, OA affects 13.9% of adults aged 25 years and older
and 33.6% (12.4 million) of those 65+ in 2005; an estimated 26.9 million US adults in
2005 up from 21 million in 1990 (believed to be conservative estimate).2
Average annual prevalence of OA in the ambulatory health care system in the United
States, from 20012005, was estimated to be 3.5% which amounts to 7.7 million with
OA.3
Average annual prevalence of OA in the ambulatory health care system in the United
States, from 20012005, was estimated to be 3.5% which amounts to 7.7 million with
OA.3
o Knee
Age 60 years= 37.4 (42.1 female; 31.2 male).4
Age 60 years= 47.8.5
Age 45 years= 19.2 (19.3 female; 18.6 male.6
Age 45 years= 37.4 (42.1 female; 31.2 male.7
Age 26 years=4.9 (4.9 female; 4.6 male.6
o Hip
Age 45 years = 28.0 (29.5 female; 25.4 male).8
Symptomatic radiographic OAprevalence per 100
o Hand
Age 26 years = 6.8 (9.2 female; 3.8male).9
 Age 60 years= 8.0 overall.10
o Knee
Age 60 years= 12.1 (10.0 female; 13.6 male).4
Age 45 years= 6.7 (7.2 female; 5.9 male).6
Age 45 years= 16.7 (18.7 female; 13.5 male).7
Age 26 years= 4.9 (4.9 female; 4.6 male).6
o Hip
Age 45 years = 8.7 (9.3 female; 9.2 male).6

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III. Incidence

Age and sex-standardized incidence rates of symptomatic radiographic OA in the in

adults aged 20 years and older:
o Hand OA = 100 per 100,000 person years.11
o Hip OA = 88 per 100,000 person years.11
o Knee OA = 240 per 100,000 person years.11
Among women in the adult population:
o Incident radiographic knee OA 2-2.5% per year.5, 12, 13
o Incident symptomatic radiographic knee OA 1% per year.12
o Progressive radiographic knee OA 3-4% per year.5,12,13
Incidence rates of OA increased with age, and level off around age 80.14
Women had higher rates than men, especially after age 50.14
o Men have 45% lower risk of incident knee OA and 36% reduced risk of hip
OA than women.15

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IV. Mortality

OA is associated with excess mortality.16

o Deaths from all causes, cardiovascular deaths, and dementia deaths among
adults with OA were 1.6,1.7, and 2.0 times higher compared with the general
population.16
Annual average of 0.2 to 0.3 deaths per 100,000 population due to OA (19791988).17
OA accounts for ~6% of all arthritis-related deaths.17
~ 500 deaths per year attributed to OA; numbers increased during the past 10 years.17
OA deaths are likely highly underestimated. For example, gastrointestinal bleeding
due to treatment with NSAIDs is not counted. 17

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V. Hospitalizations

OA accounts for 69.9% of all arthritis-related hospitalizations; 814,900

hospitalizations for OA as principal diagnosis in 2006.18
 Knee and hip joint replacement procedures (usually for OA) accounted for 35% of
total arthritis-related procedures during hospitalization.19
Nationally, from 1991 to 2007 the rate (per 100,000) of total knee replacement
increased 187% from 192.2 to 551.3. In addition, the rate (per 100,000) of total hip
replacement increased 86.2% from 135.7 to 252.7.18
Non-Hispanic Blacks and persons with low income have lower rates of total knee
replacement but higher complications and mortality than Non-Hispanic whites.20,21

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VI. Ambulatory Care

OA accounted for an annual prevalence of 20.9 million (26.8%) of all arthritis-related

ambulatory medical care visits from 2001-2005.3
About 39% of people with OA report inability to access needed health care
rehabilitative services.22

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VII. Costs

Estimated costs due to hospital expenditures of total knee and hip joint replacements,
respectively, $28.5 billion and $13.7 billion in 2009.23
Average direct costs of OA per patient ~$2,600 per year.19
Total (direct and indirect) annual costs of OA per patient = $5700 (US dollars
FY2000).24
Job-related OA costs $3.4 to $13.2 billion per year.14

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VIII. Impact on health-related quality of life (HRQOL) [AAOS Fact Sheet; NHANES
III data]

OA of the knee is 1 of 5 leading causes of disability among non-institutionalized

adults. 25
About 80% of patients with OA have some degree of movement limitation.
o 25% cannot perform major activities of daily living (ADL's), 11% of adults
with knee OA need help with personal care and 14% require help with routine
needs.
About 40% of adults with knee OA reported their health "poor" or "fair."
In 1999, adults with knee OA reported more than 13 days of lost work due to health
problems.
Hip/knee OA ranked high in disability adjusted life years (DALYs)27 and years lived
with disability (YLDs).26

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IX. Unique characteristics

Disease in weight bearing joints has greater clinical impact.

 About 20%35% of knee OA and ~50% of hip and hand OA may be genetically
determined.27,28
Established modifiable and non-modifiable risk factors7,27,28,29,30,31:
o Modifiable
Excess body mass (especially knee OA).
Joint injury (sports, work, trauma).
Knee pain.
Hand OA is a risk factor for knee OA.
Occupation (due to excessive mechanical stress: hard labor, heavy
lifting, knee bending, repetitive motion).
Menoften due to work that includes construction/mechanics,
agriculture, blue collar laborers, and engineers.
Womenoften due to work that includes cleaning,
construction, agriculture, and small business and retail.
Structural malalignment, muscle weakness.
o Non-modifiable.
Gender (women higher risk).
Age (increases with age and levels around age 75).
Race (some Asian populations have lower risk).
Genetic predisposition.

Other possible factors:

o Estrogen deficiency (estrogen replacement therapy (ERT) may reduce risk of
knee/hip OA).
o High bone density may increase risk of knee).
o Vitamins C, E, and Dequivocal reports.
o C-reactive protein (increased risk with higher levels).

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X. References

1. American Academy of Orthopaedic Surgeons. Osteoarthritis.

http://orthoinfo.aaos.org/topic.cfm?topic=a00227 Accessed 04-07-2014
2. Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis
and other rheumatic conditions in the United States. Part II. Arthritis Rheum.
2008;58(1):26-35.
3. Sacks JJ, Luo Y-H, Helmick CG. Prevalence of specific types of arthritis and other
rheumatic conditions in the ambulatory health care system in the
United States, 20012005. Arthritis Care & Research. 2010;62 (4):460-464.
4. Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United
States: arthritis data from the Third National Health and Nutrition Examination
Survey 19911994. J Rheumatol, 2006;33(11):2271-2279.
5. Leyland KM, Hart DJ, Javaid MK, Judge A, et al. The natural history of radiographic
knee osteoarthritis: a fourteen-year population-based cohort study. Arthritis Rheum
2012;64(7):2243-51.
6. Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence
of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis
Rheum. 1987;30(8):914-918.
7. Jordan JM, Helmick CG, Renner JB, et al. Prevalence of knee symptoms and
radiographic and symptomatic knee osteoarthritis in African Americans and
Caucasians: The Johnston County Osteoarthritis Project. J Rheumatol.
2007;34(1):172-180.
8. Jordan JM, Helmick CG, Renner JB, et al. Prevalence of hip symptoms and
radiographic and symptomatic hip osteoarthritis in African Americans and
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and its impact on functional status among elderly: the Framingham Study. Am J
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18. Arthritis and Related Conditions Chapter 4.
http://www.boneandjointburden.org/pdfs/BMUS_chpt4_arthritis.pdf . Accessed
04-07-2014
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with arthritis. J Rheumatol. 1997;24(4):719725.
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