Is Work Load a Risk Factor for Osteoarthritis of the Hip? A Systematic Review

man pulling pallet

A previous blog by one of our industrious Musculoskeletal Elves looked at how osteoarthritis (OA) of the hip or knee affected work participation. This got me thinking about the converse situation – can work be a predisposing factor for the development of OA? We Elves are involved in quite a lot of heavy lifting, particularly around Christmas – would this be something that might cause us problems later on in life? It was then that I stumbled across a very interesting systematic review on the epidemiological evidence for work load as a risk factor for OA of the hip by Sulsky et al (2012) published in PLoS One, an online journal.

Here’s what they did

The review authors conducted comprehensive searches of the scientific literature particularly looking for quantitative estimates of exposure to occupational activities that might increase the risk of hip OA. Only studies with high quality designs and quantitative exposure data were included, as previous reviews have been qualitative, focusing on the authors’ judgment regarding the association between physical work load and hip OA.

Here’s what they found

man lifting box

Long-term exposure to heavy lifting increases risk of hip OA and standing at work might increase the risk of hip OA

Using pre-defined quality criteria, 30 studies were selected for critical evaluation; however, only six of these provided quantitative exposure data. Study results were too heterogeneous to develop pooled risk estimates by specific work activities. However, what they were able to determine was that the weight of evidence favours a graded association between long-term exposure to heavy lifting and risk of hip OA. Long-term exposure to standing at work might also increase the risk of hip OA.

The authors concluded

“There is enough evidence available to identify job-related heavy lifting and standing as hazards, and thus to begin developing recommendations for preventing hip OA by limiting the amount and duration of these activities.”

The Musculoskeletal Elf’s view

picture of the musculoskeletal elf

Certainly the last thing I want to do is look like I am discouraging anyone from working, as I am a firm believer that work is good for you, as evidence clearly indicates on the Health Work Wellbeing website supported by the UK’s Department for Work and Pensions. Furthermore, an Arthritis Care survey in 2005 found that people with osteoarthritis in employment experienced pain less frequently than those out of work. So I put to you some of the authors’ recommendations for OA prevention for your consideration.
  •  Job activities with high physical work load should be minimised to the extent possible.
  • Training and guidelines for appropriate ergonomic approaches to materials handling and other work activities should be made available and implemented.
  • In workplaces where jobs require exposure to high work load, organisations should promote preventive health measures for workers. Programmes should focus on limiting exposure to extended standing, etc.
  • Better work organisation may reduce unnecessary physical work load.
  • Older employees and employees with hip disorders, hip deformity, former injuries or known intrinsic risks for total hip replacement should not be exposed to high physical work load.


Sulsky SI, Carlton L, Bochmann F, Ellegast R, Glitsch U, et al. (2012) Epidemiological Evidence for Work Load as a Risk Factor for Osteoarthritis of the Hip:
A Systematic Review. PLoS ONE 7(2): e31521. doi:10.1371/journal.pone.0031521

Health Work Wellbeing [online] (accessed 30-8-12)

Arthritis Care [online] (accessed 30-8-12)

How do the recommendations from this review marry up with what you would recommend to your patients? How will this review influence your clinical practice? 

Please send us your comments on this blog and become part of the ever expanding Musculoskeletal Elf community.

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Heather Gray

I am currently the Head of Physiotherapy & Paramedicine at Glasgow Caledonian University and Chair of the Chartered Society of Physiotherapy's Professional Committee. I have worked at the University of Glasgow in several research positions. I am on the Editorial Board of the Journal of Physical Therapy Education. Other work in which I have been involved is as an Educational Consultant with NHS Education for Scotland. Prior to moving into academia I worked in the National Health Service (NHS) in Scotland as a physiotherapist for 11 years.

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