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Reduced functional performance in the lower extremity predicted radiographic knee osteoarthritis five years later
  1. C A Thorstensson1,
  2. I F Petersson1,
  3. L T H Jacobsson1,2,
  4. T L Boegård1,3,
  5. E M Roos1,4
  1. 1Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden
  2. 2Department of Rheumatology, Malmö University Hospital, Malmö, Sweden
  3. 3Department of Radiology, County Hospital, Helsingborg, Sweden
  4. 4Department of Orthopaedics, Lund University Hospital, Lund, Sweden
  1. Correspondence to:
    Dr C Thorstensson
    Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden, S-313 92;


Background: Reduced quadriceps strength is an early finding in subjects with knee osteoarthritis, but it is not clear whether it is a cause or a consequence of knee osteoarthritis.

Objective: To determine whether reduced functional performance in the lower extremity predicts the incidence or progression of radiographic knee osteoarthritis.

Design: Prospective, epidemiological, population based cohort study.

Patients: 148 subjects (62 women), aged 35–54 (mean 44.8), with chronic knee pain from a population based cohort.

Measurements: Predictors analysed were age, sex, body mass index, baseline knee pain, and three tests of lower extremity functional performance: maximum number of one-leg rises from sitting, time spent walking 300 m, and timed standing on one leg. Weightbearing tibiofemoral knee radiographs were obtained at baseline and after 5 years (median 5.1, range 4.2–6.1), and classified according to Kellgren and Lawrence as no osteoarthritis (Kellgren and Lawrence = 0, n = 94) or prevalent osteoarthritis (Kellgren and Lawrence ⩾1, n = 54).

Results: Fewer one-leg rises (median 17 v 25) predicted incident radiographic osteoarthritis five years later (OR 2.6, 95% CI 1.1 to 6.0). The association remained significant after controlling for age, sex, body mass index, and pain. No significant predictor of radiographic progression in the group with prevalent osteoarthritis was found.

Conclusion: Reduced functional performance in the lower extremity predicted development of radiographic knee osteoarthritis 5 years later among people aged 35–55 with chronic knee pain and normal radiographs at baseline. These findings suggest that a test of one-leg rises may be useful, and interventions aimed at improving functional performance may be protective against development of knee osteoarthritis.

  • epidemiology
  • knees
  • osteoarthritis
  • physical endurance
  • risk factors

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