University of Oulu

Wallace, I., Worthington, S., Felson, D., Jurmain, R., Wren, K., Maijanen, H., Woods, R., Lieberman, D. (2017) Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proceedings of the National Academy of Sciences, 114 (35), 9332-9336. doi:10.1073/pnas.1703856114

Knee osteoarthritis has doubled in prevalence since the mid-20th century

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Author: Wallace, Ian J.1; Worthington, Steven2; Felson, David T.3;
Organizations: 1Department of Human Evolutionary Biology, Harvard University
2Institute for Quantitative Social Science, Harvard University
3Clinical Epidemiology Unit, Boston University School of Medicine
4Department of Anthropology, San Jose State University
5Department of Anthropology, University of Tennessee
6Laboratory of Archeology, University of Oulu
7Battelle Memorial Institute
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: National Academy of Sciences of the United States of America, 2017
Publish Date: 2017-09-08


Knee osteoarthritis (OA) is believed to be highly prevalent today because of recent increases in life expectancy and body mass index (BMI), but this assumption has not been tested using long-term historical or evolutionary data. We analyzed long-term trends in knee OA prevalence in the United States using cadaver-derived skeletons of people aged ≥50 y whose BMI at death was documented and who lived during the early industrial era (1800s to early 1900s; n = 1,581) and the modern postindustrial era (late 1900s to early 2000s; n = 819). Knee OA among individuals estimated to be ≥50 y old was also assessed in archeologically derived skeletons of prehistoric hunter-gatherers and early farmers (6000–300 B.P.; n = 176). OA was diagnosed based on the presence of eburnation (polish from bone-on-bone contact). Overall, knee OA prevalence was found to be 16% among the postindustrial sample but only 6% and 8% among the early industrial and prehistoric samples, respectively. After controlling for age, BMI, and other variables, knee OA prevalence was 2.1-fold higher (95% confidence interval, 1.5–3.1) in the postindustrial sample than in the early industrial sample. Our results indicate that increases in longevity and BMI are insufficient to explain the approximate doubling of knee OA prevalence that has occurred in the United States since the mid-20th century. Knee OA is thus more preventable than is commonly assumed, but prevention will require research on additional independent risk factors that either arose or have become amplified in the postindustrial era.

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Series: Proceedings of the National Academy of Sciences of the United States of America
ISSN: 0027-8424
ISSN-E: 1091-6490
ISSN-L: 0027-8424
Volume: 114
Issue: 35
Pages: 9332 - 9336
DOI: 10.1073/pnas.1703856114
Type of Publication: A1 Journal article – refereed
Field of Science: 616 Other humanities
Dataset Reference: This article contains supporting information online at:
Copyright information: Freely available online through the PNAS open access option.