Disclosures The Changing Demographics of End-Stage Hip and Knee Osteoarthritis Joanne M. Jordan, MD MPH University of North Carolina Rheumatology, Allergy and Immunology Johnson & Johnson: contract, consultant Algynomics, Inc.: consultant, stock options Eli Lilly: consultant Interleukin Genetics, Inc.: consultant Evidence Wills AK, Black S, Cooper R. et al. Life course body mass index and risk of knee osteoarthritis at the age of 53 years. Ann Rheum Dis (2011). doi:10.1136/ard 2011.154021 Caine DM, Golightly YM. Osteoarthritis as an outcome of paediatric sport. Br J Sports Med 2011;45:298 303. doi:10.1136/298 bjsm.2010.081984 Singh JA. Epidemiology of Knee and Hip Arthroplasty: A Systematic Review. The Open Orthopaedics Journal, 2011, 5, 80-85 End-stage hip & knee OA epidemiology To understand how changes in aging of the population obesity rates knee injuries in young people impact rates of OA future demand for TJR OA: Risk factors Aging Occupation Genetics Diet Joint injury Obesity 1
TKA/1,000 by age and year Medicare AGE 2000 2006 65-74 5.4 9.1 75-84 6.6 10.2 85+ 2.6 4.0 MMWR, 2009 Singh JA, The Open Orthopaedics Journal, 2011 THA in Olmsted County, MN OA Policy Model state-transition computer simulation model NHANES III, NHANES 2007-08, Census FOS, JoCo OA Singh JA et al. Mayo Cl Proc 2010 TKA in Olmsted County, MN Transitions among health states in the OAPol Model.The circles represent the 4 major health states in the OAPol Model. Forecasting burden of OA 13% of 14,338,292 adults 60 64 years old have sx rkoa Survival x 10 years 20% will have sx advanced or end-stage rkoa 10% in non-obese 35% in obese Losina E et al. Ann Intern Med 2011;154:217-226 2011 by American College of Physicians HL Holt et al. OAC, 2011 2
OA Pol computer model Quality-adjusted life years lost effect of reducing obesity levels to 10 years ago Losina E et al. Ann Intern Med 2011;154:217-226 Results: JoCo OA Project Lifetime risk of sx Knee OA BMI, kg/m 2 Lifetime risk % (95% CI) <25 30.2 (23.0-37.4) TF-OA (K-L grade) 25-<30 (overweight) 46.9 (39.3-54.5) : aor= 1.36 (1.00-1.86) apor= 2.08 (1.19-3.65) Femur 30 (obese) 60.5 (53.0-68.1) History of knee injury : aor= 1.00 (0.81-1.23) apor= 1.56 (1.06-2.29) Tibia No 42.3 (37.2-47.4) Yes 56.8 (48.4-65.2) Overall 44.7 (40.0-49.3) Braga L, et al. Osteo & Cart 2009 Murphy L, et al. Arthritis Rheum 2008;59(9):1207-13. BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5 4 person) 1990 2000 2010 3
BRFSS, 1985 BRFSS, 1986 No Data <10% 10% 14% No Data <10% 10% 14% BRFSS, 1987 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) BRFSS, 1988 No Data <10% 10% 14% No Data <10% 10% 14% BRFSS, 1989 BRFSS, 1990 No Data <10% 10% 14% No Data <10% 10% 14% 4
BRFSS, 1991 BRFSS, 1992 No Data <10% 10% 14% 15% 19% No Data <10% 10% 14% 15% 19% BRFSS, 1993 BRFSS, 1994 No Data <10% 10% 14% 15% 19% No Data <10% 10% 14% 15% 19% BRFSS, 1995 BRFSS, 1996 No Data <10% 10% 14% 15% 19% No Data <10% 10% 14% 15% 19% 5
BRFSS, 1997 BRFSS, 1998 No Data <10% 10% 14% 15% 19% 20% No Data <10% 10% 14% 15% 19% 20% BRFSS, 1999 BRFSS, 2000 No Data <10% 10% 14% 15% 19% 20% No Data <10% 10% 14% 15% 19% 20% BRFSS, 2001 BRFSS, 2002 No Data <10% 10% 14% 15% 19% 20% 24% 25% No Data <10% 10% 14% 15% 19% 20% 24% 25% 6
BRFSS, 2003 BRFSS, 2004 No Data <10% 10% 14% 15% 19% 20% 24% 25% No Data <10% 10% 14% 15% 19% 20% 24% 25% BRFSS, 2005 BRFSS, 2006 BRFSS, 2007 BRFSS, 2008 7
BRFSS, 2009 BRFSS, 2010 Childhood obesity Childhood obesity Lifetime BMI & KOA Medical Research Council National Survey of Health & Development 2547 women + 2815 men since birth Outcome: ACR clinical koa @ 53 yrs? Prolonged exposure to high BMI? Exposure at set times to high BMI Lifetime BMI & KOA METHODS Ht and wt measured 2, 4, 7, 11, 15, 36, 43, 53 years Ht and wt self-reported 20, 26 years Confounders manual vs non-manual job, age 43 sports and recreation, age 36 Wills AK et al. ARD Online First, Oct 6, 2011 Wills AK et al. ARD Online First, Oct 6, 2011 8
Lifetime BMI & KOA Mean lifetime body mass index (BMI) z-score and 95% CI (shaded area) in men (A) and women (B) among those with knee osteoarthritis (OA; solid line) at age 53 years. Critical Periods assessed Childhood: 2-7 yrs Childhood to adolescence: 7-15 yrs Adolescent to young adult: 15-20 yrs Early adulthood: 20-36 yrs Mid-adulthood: 36-53 yrs Wills AK et al. ARD Online First, Oct 6, 2011 Wills A K et al. Ann Rheum Dis doi:10.1136/ard.2011.154021 2011 by BMJ Publishing Group Ltd and European League Against Rheumatism Lifetime BMI & KOA MEN: high BMI @ 43 yrs most predictive, some effect of duration WOMEN: best model with BMI @ 43 yrs and duration High BMI in childhood or adolescence not independent of adulthood BMI Lifetime BMI & KOA Weight control throughout life Risk accumulates through adulthood BMI tracks childhood to adulthood? Early weight control more effective BUT, adult weight loss can risk Wills AK et al. ARD Online First, Oct 6, 2011 Wills AK et al. ARD Online First, Oct 6, 2011 Does childhood obesity lead to earlier age of onset of OA? Biomechanics in obese adolescents?? abstract #2510, Epid concurrent Sagittal and frontal plane joint mechanics throughout the stance phase of walking in adolescents who are obese A.G. McMillan et al. Gait & Posture 32 (2010) 263 268 9
County-level Estimates of Leisure-time Physical Inactivity among Adults aged 20 years: United States 2008 Age-adjusted ranks based on age-adjusted percent of leisure-time physical inactivity Above median rank Below median rank Not above median rank or below median rank www.cdc.gov/diabetes Post-traumatic OA approximately 12% of total OA 5.6 million U.S. adults have PT-OA of the knee, hip or ankle $3.1 billion annually for healthcare costs Lifetime risk of knee PT-OA is 57% ACL ruptures and ankle fx incident OA OA & ACL sports injury Swedish male soccer players Aged 16-42 at injury OA & ACL sports injury 102 Swedish female soccer Aged < 20 yrs at injury 12 years 14 years -------- Advanced roa in injured knee 41% vs 4% ---------------- advanced OA in injured knee 51% vs 8% Van Porat et al. ARD 2004 Lohmander et al Arthritis Rheum 2004 10
Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective Dennis J Caine and Yvonne M Golightly Br J Sports Med 2011 45: 298-303 (A) Standing frontal radiograph of both knees showing physial widening of both medial distal femoral physes and both medial proximal tibial physes. 27M children + adolescents aged 6-17 yrs (50%) play team sports in US + many others in individual sports 1 65% of sports & recreational injury ER visits (2.8M) were in those < 19 y/o 2 1 Sporting Goods Manufacturers Association, 2009 2 MMWR, 2002 Caine D J, Golightly Y M Br J Sports Med 2011;45:298-303 Copyright BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved. Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective Dennis J Caine and Yvonne M Golightly Br J Sports Med 2011 45: 298-303 Interventions to prevent injury balance-training structured warm-up neuromuscular control proprioception strength and flexibility training weekly injury and participation data by certified athletic trainers through an easily navigated website evidence-based injury prevention efforts and policies RIO: reportable injury organized HS practice or competition in past week AND required medical attention by a team athletic trainer or a physician AND restricted student-athlete's participation 1 days beyond day of injury OR resulted in any fracture, concussion, or dental injury regardless of restriction of the student-athlete's participation The number of injuries reported in the weekly exposure report should match the number of injury report forms submitted for the week. If you become aware of additional injuries, please update the weekly exposure report with the new number of injuries. The completed Week 1 exposure report can be modified by clicking Exposure Report Form 11
JUMP-ACL UNC IPRC + 3 military academies Detailed biomechanics phenotyping pre-injury Follow for injury and beyond OA & sports w/o injury ACR abstract #1977 rkoa, clinical KOA, TKA or wait list sport participation vs sport participation w/ injury elite vs non-elite risk sport-specific w/ or w/out injury OARSI FDA Prevention Working Group 1 and 2 prevention and risk reduction of structural and symptomatic KOA Jordan JM, Sowers MF, Messier SP, et al. OAC, 2011 Conclusions Severe symptomatic OA is a significant public health issue. Age Obesity, childhood, lifecourse Joint injury TKA and THA are increasing in frequency. all ages racial/ethnic disparities persistent Conclusions Obesity and joint injury can be prevented. Preventive interventions should begin early. 12