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Ann Rheum Dis. 2001 Feb; 60(2): 91–97.
PMCID: PMC1753462

Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care


BACKGROUND—Osteoarthritis is the single most common cause of disability in older adults, and most patients with the condition will be managed in the community and primary care.
AIM—To discuss case definition of knee osteoarthritis for primary care and to summarise the burden of the condition in the community and related use of primary health care in the United Kingdom.
DESIGN—Narrative review.
METHOD—A literature search identified studies of incidence and prevalence of knee pain, disability, and radiographic osteoarthritis in the general population, and data related to primary care consultations. Findings from UK studies were summarised with reference to European and international studies.
RESULTS—During a one year period 25% of people over 55 years have a persistent episode of knee pain, of whom about one in six in the UK and the Netherlands consult their general practitioner about it in the same time period. The prevalence of painful disabling knee osteoarthritis in people over 55 years is 10%, of whom one quarter are severely disabled.
CONCLUSION—Knee osteoarthritis sufficiently severe to consider joint replacement represents a minority of all knee pain and disability suffered by older people. Healthcare provision in primary care needs to focus on this broader group to impact on community levels of pain and disability.

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Selected References

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  • Lane NE, Thompson JM. Management of osteoarthritis in the primary-care setting: an evidence-based approach to treatment. Am J Med. 1997 Dec 29;103(6A):25S–30S. [PubMed]
  • 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 Aug;30(8):914–918. [PubMed]
  • van Saase JL, van Romunde LK, Cats A, Vandenbroucke JP, Valkenburg HA. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis. 1989 Apr;48(4):271–280. [PMC free article] [PubMed]
  • Claessens AA, Schouten JS, van den Ouweland FA, Valkenburg HA. Do clinical findings associate with radiographic osteoarthritis of the knee? Ann Rheum Dis. 1990 Oct;49(10):771–774. [PMC free article] [PubMed]
  • Odding E, Valkenburg HA, Algra D, Vandenouweland FA, Grobbee DE, Hofman A. Associations of radiological osteoarthritis of the hip and knee with locomotor disability in the Rotterdam Study. Ann Rheum Dis. 1998 Apr;57(4):203–208. [PMC free article] [PubMed]
  • McAlindon TE, Snow S, Cooper C, Dieppe PA. Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis. 1992 Jul;51(7):844–849. [PMC free article] [PubMed]
  • Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039–1049. [PubMed]
  • Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, Moskowitz RW, Schnitzer TJ. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheumatology. Arthritis Rheum. 1995 Nov;38(11):1541–1546. [PubMed]
  • McAlindon T, Dieppe P. Osteoarthritis: definitions and criteria. Ann Rheum Dis. 1989 Jul;48(7):531–532. [PMC free article] [PubMed]
  • McAlindon TE. Regional musculoskeletal pain. The knee. Baillieres Best Pract Res Clin Rheumatol. 1999 Jun;13(2):329–344. [PubMed]
  • Mazzuca SA, Brandt KD, Katz BP, Dittus RS, Freund DA, Lubitz R, Hawker G, Eckert G. Comparison of general internists, family physicians, and rheumatologists managing patients with symptoms of osteoarthritis of the knee. Arthritis Care Res. 1997 Oct;10(5):289–299. [PubMed]
  • Dieppe PA, Cushnaghan J, Shepstone L. The Bristol 'OA500' study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint. Osteoarthritis Cartilage. 1997 Mar;5(2):87–97. [PubMed]
  • Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman B, Aliabadi P, Levy D. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. Arthritis Rheum. 1997 Apr;40(4):728–733. [PubMed]
  • McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Knee pain and disability in the community. Br J Rheumatol. 1992 Mar;31(3):189–192. [PubMed]
  • O'Reilly SC, Muir KR, Doherty M. Screening for pain in knee osteoarthritis: which question? Ann Rheum Dis. 1996 Dec;55(12):931–933. [PMC free article] [PubMed]
  • Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, Simmons A, Williams G. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998 Nov;57(11):649–655. [PMC free article] [PubMed]
  • Badley EM, Tennant A. Changing profile of joint disorders with age: findings from a postal survey of the population of Calderdale, West Yorkshire, United Kingdom. Ann Rheum Dis. 1992 Mar;51(3):366–371. [PMC free article] [PubMed]
  • Anderson JJ, Felson DT. Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. Am J Epidemiol. 1988 Jul;128(1):179–189. [PubMed]
  • Lethbridge-Cejku M, Scott WW, Jr, Reichle R, Ettinger WH, Zonderman A, Costa P, Plato CC, Tobin JD, Hochberg MC. Association of radiographic features of osteoarthritis of the knee with knee pain: data from the Baltimore Longitudinal Study of Aging. Arthritis Care Res. 1995 Sep;8(3):182–188. [PubMed]
  • Woo J, Ho SC, Lau J, Leung PC. Musculoskeletal complaints and associated consequences in elderly Chinese aged 70 years and over. J Rheumatol. 1994 Oct;21(10):1927–1931. [PubMed]
  • Bergström G, Bjelle A, Sundh V, Svanborg A. Joint disorders at ages 70, 75 and 79 years--a cross-sectional comparison. Br J Rheumatol. 1986 Nov;25(4):333–341. [PubMed]
  • Andersen S, Winckler F. The epidemiology of primary osteoarthrosis of the knee in Greenland. Arch Orthop Trauma Surg. 1979 Jan 29;93(2):91–94. [PubMed]
  • Zhang N, Shi Q, Zhang X. [An epidemiological study of knee osteoarthritis]. Zhonghua Nei Ke Za Zhi. 1995 Feb;34(2):84–87. [PubMed]
  • Jordan JM, Linder GF, Renner JB, Fryer JG. The impact of arthritis in rural populations. Arthritis Care Res. 1995 Dec;8(4):242–250. [PubMed]
  • Sun Y, Günther KP, Brenner H. Reliability of radiographic grading of osteoarthritis of the hip and knee. Scand J Rheumatol. 1997;26(3):155–165. [PubMed]
  • Tennant A, Fear J, Pickering A, Hillman M, Cutts A, Chamberlain MA. Prevalence of knee problems in the population aged 55 years and over: identifying the need for knee arthroplasty. BMJ. 1995 May 20;310(6990):1291–1293. [PMC free article] [PubMed]
  • Lequesne MG. The algofunctional indices for hip and knee osteoarthritis. J Rheumatol. 1997 Apr;24(4):779–781. [PubMed]
  • Hart DJ, Doyle DV, Spector TD. Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study. Arthritis Rheum. 1999 Jan;42(1):17–24. [PubMed]
  • McAlindon TE, Wilson PW, Aliabadi P, Weissman B, Felson DT. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med. 1999 Feb;106(2):151–157. [PubMed]
  • Odding E, Valkenburg HA, Algra D, Vandenouweland FA, Grobbee DE, Hofman A. The association of abnormalities on physical examination of the hip and knee with locomotor disability in the Rotterdam Study. Br J Rheumatol. 1996 Sep;35(9):884–890. [PubMed]
  • Roland M, Jamoulle M. "Docteur, j'ai mal au genou ...", le point de vue du généraliste. Rev Med Brux. 1997 Sep;18(4):294–300. [PubMed]
  • Abyad A, Boyer JT. Arthritis and aging. Curr Opin Rheumatol. 1992 Apr;4(2):153–159. [PubMed]
  • Oliveria SA, Felson DT, Reed JI, Cirillo PA, Walker AM. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum. 1995 Aug;38(8):1134–1141. [PubMed]
  • Kannus P, Järvinen M, Kontiala H, Bergius L, Hyssy E, Salminen E, Tuomi A, Unkila T, Valtanen I. Occurrence of symptomatic knee osteoarthrosis in rural Finland: a prospective follow up study. Ann Rheum Dis. 1987 Nov;46(11):804–808. [PMC free article] [PubMed]
  • Wilson MG, Michet CJ, Jr, Ilstrup DM, Melton LJ., 3rd Idiopathic symptomatic osteoarthritis of the hip and knee: a population-based incidence study. Mayo Clin Proc. 1990 Sep;65(9):1214–1221. [PubMed]
  • Dieppe P. Osteoarthritis: time to shift the paradigm. This includes distinguishing between severe disease and common minor disability. BMJ. 1999 May 15;318(7194):1299–1300. [PMC free article] [PubMed]
  • Lanyon P, O'Reilly S, Jones A, Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis. 1998 Oct;57(10):595–601. [PMC free article] [PubMed]
  • Birrell F, Johnell O, Silman A. Projecting the need for hip replacement over the next three decades: influence of changing demography and threshold for surgery. Ann Rheum Dis. 1999 Sep;58(9):569–572. [PMC free article] [PubMed]

Figures and Tables

Figure 1
The prevalence staircase. Shading represents the proportion in each category with radiographic evidence of knee osteoarthritis. *The proportion with radiographic evidence in this category is not known, though seems likely to be high.
Figure 2
The consultation prevalence staircase.

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