Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes

Madeleine A M Davies, Zachary Y Kerr, J D DeFreese, Nigel K Arden, Stephen W Marshall, Kevin M Guskiewicz, Darin A Padua, Brian Pietrosimone

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Osteoarthritis is a substantial cause of disability. Joint replacement prevalence relates to the burden of severe osteoarthritis, and identifying risk factors for end-stage disease may indicate intervention opportunities. American football has high youth and elite participation, and determining risk factors for severe osteoarthritis may support future morbidity prevention.

PURPOSE: To (1) determine the prevalence of hip and knee replacement in retired National Football League (NFL) athletes, (2) examine risk factors for replacement, and (3) identify the association between knee injuries and knee replacement.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: Retired NFL athletes who participated in a general health survey were included. This historical cohort included those playing between 1929 and 2001. The association between self-reported playing or injury history, and replacement after retirement, was assessed with prevalence ratios (PRs). Models were adjusted for potential confounders of age and weight.

RESULTS: Data for 2432 retired male NFL players (69.3% response rate) who had participated in football for a mean 15.2 years were included, in which 277 players reported replacement after retirement (11.4%). More participants reported knee replacement (7.7%) than hip replacement (4.6%). The majority of participants reported previous severe knee injury (53%), and the most prevalent was meniscal tear (32.2%). In multivariable models, age (10-year increase, PR, 2.23; 95% CI, 1.99-2.51), current weight (PR, 1.10; 95% CI, 1.06-1.14), and reporting 1 (PR, 1.78; 95% CI, 1.14-2.77), 2 (PR, 1.91; 95% CI, 1.16-3.15), or ≥3 knee injuries (PR, 3.44; 95% CI, 2.33-5.09) were associated with knee replacement. Age (10-year increase, PR, 1.86; 95% CI, 1.59-2.18), linemen (PR, 1.62; 95% CI, 1.03-2.55), and reporting 1 (PR, 1.72; 95% CI, 1.05-2.80), 2 (PR, 2.77 95% CI, 1.58-4.84), or ≥3 (PR, 2.44; 95% CI, 1.52-3.91) hip injuries were associated with hip replacement. Each reported knee injury type was cross-sectionally associated with replacement after retirement (P < .05).

CONCLUSION: Knee replacement was more prevalent than hip replacement. Risk factors differed between the hip and the knee, with age and severe joint injury associated with hip and knee replacement, weight with knee replacement, and playing position associated with hip replacement. Joint injury and weight management may be prevention opportunities to reduce morbidity and end-stage osteoarthritis in this population.

Original languageEnglish
Pages (from-to)2863-2870
Number of pages8
JournalThe American Journal of Sports Medicine
Volume47
Issue number12
Early online date9 Sep 2019
DOIs
Publication statusPublished - 1 Oct 2019

Cite this

Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes. / Davies, Madeleine A M; Kerr, Zachary Y; DeFreese, J D; Arden, Nigel K; Marshall, Stephen W; Guskiewicz, Kevin M; Padua, Darin A; Pietrosimone, Brian.

In: The American Journal of Sports Medicine, Vol. 47, No. 12, 01.10.2019, p. 2863-2870.

Research output: Contribution to journalArticle

Davies, MAM, Kerr, ZY, DeFreese, JD, Arden, NK, Marshall, SW, Guskiewicz, KM, Padua, DA & Pietrosimone, B 2019, 'Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes', The American Journal of Sports Medicine, vol. 47, no. 12, pp. 2863-2870. https://doi.org/10.1177/0363546519870804
Davies, Madeleine A M ; Kerr, Zachary Y ; DeFreese, J D ; Arden, Nigel K ; Marshall, Stephen W ; Guskiewicz, Kevin M ; Padua, Darin A ; Pietrosimone, Brian. / Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes. In: The American Journal of Sports Medicine. 2019 ; Vol. 47, No. 12. pp. 2863-2870.
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title = "Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes",
abstract = "BACKGROUND: Osteoarthritis is a substantial cause of disability. Joint replacement prevalence relates to the burden of severe osteoarthritis, and identifying risk factors for end-stage disease may indicate intervention opportunities. American football has high youth and elite participation, and determining risk factors for severe osteoarthritis may support future morbidity prevention.PURPOSE: To (1) determine the prevalence of hip and knee replacement in retired National Football League (NFL) athletes, (2) examine risk factors for replacement, and (3) identify the association between knee injuries and knee replacement.STUDY DESIGN: Case-control study; Level of evidence, 3.METHODS: Retired NFL athletes who participated in a general health survey were included. This historical cohort included those playing between 1929 and 2001. The association between self-reported playing or injury history, and replacement after retirement, was assessed with prevalence ratios (PRs). Models were adjusted for potential confounders of age and weight.RESULTS: Data for 2432 retired male NFL players (69.3{\%} response rate) who had participated in football for a mean 15.2 years were included, in which 277 players reported replacement after retirement (11.4{\%}). More participants reported knee replacement (7.7{\%}) than hip replacement (4.6{\%}). The majority of participants reported previous severe knee injury (53{\%}), and the most prevalent was meniscal tear (32.2{\%}). In multivariable models, age (10-year increase, PR, 2.23; 95{\%} CI, 1.99-2.51), current weight (PR, 1.10; 95{\%} CI, 1.06-1.14), and reporting 1 (PR, 1.78; 95{\%} CI, 1.14-2.77), 2 (PR, 1.91; 95{\%} CI, 1.16-3.15), or ≥3 knee injuries (PR, 3.44; 95{\%} CI, 2.33-5.09) were associated with knee replacement. Age (10-year increase, PR, 1.86; 95{\%} CI, 1.59-2.18), linemen (PR, 1.62; 95{\%} CI, 1.03-2.55), and reporting 1 (PR, 1.72; 95{\%} CI, 1.05-2.80), 2 (PR, 2.77 95{\%} CI, 1.58-4.84), or ≥3 (PR, 2.44; 95{\%} CI, 1.52-3.91) hip injuries were associated with hip replacement. Each reported knee injury type was cross-sectionally associated with replacement after retirement (P < .05).CONCLUSION: Knee replacement was more prevalent than hip replacement. Risk factors differed between the hip and the knee, with age and severe joint injury associated with hip and knee replacement, weight with knee replacement, and playing position associated with hip replacement. Joint injury and weight management may be prevention opportunities to reduce morbidity and end-stage osteoarthritis in this population.",
author = "Davies, {Madeleine A M} and Kerr, {Zachary Y} and DeFreese, {J D} and Arden, {Nigel K} and Marshall, {Stephen W} and Guskiewicz, {Kevin M} and Padua, {Darin A} and Brian Pietrosimone",
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TY - JOUR

T1 - Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes

AU - Davies, Madeleine A M

AU - Kerr, Zachary Y

AU - DeFreese, J D

AU - Arden, Nigel K

AU - Marshall, Stephen W

AU - Guskiewicz, Kevin M

AU - Padua, Darin A

AU - Pietrosimone, Brian

PY - 2019/10/1

Y1 - 2019/10/1

N2 - BACKGROUND: Osteoarthritis is a substantial cause of disability. Joint replacement prevalence relates to the burden of severe osteoarthritis, and identifying risk factors for end-stage disease may indicate intervention opportunities. American football has high youth and elite participation, and determining risk factors for severe osteoarthritis may support future morbidity prevention.PURPOSE: To (1) determine the prevalence of hip and knee replacement in retired National Football League (NFL) athletes, (2) examine risk factors for replacement, and (3) identify the association between knee injuries and knee replacement.STUDY DESIGN: Case-control study; Level of evidence, 3.METHODS: Retired NFL athletes who participated in a general health survey were included. This historical cohort included those playing between 1929 and 2001. The association between self-reported playing or injury history, and replacement after retirement, was assessed with prevalence ratios (PRs). Models were adjusted for potential confounders of age and weight.RESULTS: Data for 2432 retired male NFL players (69.3% response rate) who had participated in football for a mean 15.2 years were included, in which 277 players reported replacement after retirement (11.4%). More participants reported knee replacement (7.7%) than hip replacement (4.6%). The majority of participants reported previous severe knee injury (53%), and the most prevalent was meniscal tear (32.2%). In multivariable models, age (10-year increase, PR, 2.23; 95% CI, 1.99-2.51), current weight (PR, 1.10; 95% CI, 1.06-1.14), and reporting 1 (PR, 1.78; 95% CI, 1.14-2.77), 2 (PR, 1.91; 95% CI, 1.16-3.15), or ≥3 knee injuries (PR, 3.44; 95% CI, 2.33-5.09) were associated with knee replacement. Age (10-year increase, PR, 1.86; 95% CI, 1.59-2.18), linemen (PR, 1.62; 95% CI, 1.03-2.55), and reporting 1 (PR, 1.72; 95% CI, 1.05-2.80), 2 (PR, 2.77 95% CI, 1.58-4.84), or ≥3 (PR, 2.44; 95% CI, 1.52-3.91) hip injuries were associated with hip replacement. Each reported knee injury type was cross-sectionally associated with replacement after retirement (P < .05).CONCLUSION: Knee replacement was more prevalent than hip replacement. Risk factors differed between the hip and the knee, with age and severe joint injury associated with hip and knee replacement, weight with knee replacement, and playing position associated with hip replacement. Joint injury and weight management may be prevention opportunities to reduce morbidity and end-stage osteoarthritis in this population.

AB - BACKGROUND: Osteoarthritis is a substantial cause of disability. Joint replacement prevalence relates to the burden of severe osteoarthritis, and identifying risk factors for end-stage disease may indicate intervention opportunities. American football has high youth and elite participation, and determining risk factors for severe osteoarthritis may support future morbidity prevention.PURPOSE: To (1) determine the prevalence of hip and knee replacement in retired National Football League (NFL) athletes, (2) examine risk factors for replacement, and (3) identify the association between knee injuries and knee replacement.STUDY DESIGN: Case-control study; Level of evidence, 3.METHODS: Retired NFL athletes who participated in a general health survey were included. This historical cohort included those playing between 1929 and 2001. The association between self-reported playing or injury history, and replacement after retirement, was assessed with prevalence ratios (PRs). Models were adjusted for potential confounders of age and weight.RESULTS: Data for 2432 retired male NFL players (69.3% response rate) who had participated in football for a mean 15.2 years were included, in which 277 players reported replacement after retirement (11.4%). More participants reported knee replacement (7.7%) than hip replacement (4.6%). The majority of participants reported previous severe knee injury (53%), and the most prevalent was meniscal tear (32.2%). In multivariable models, age (10-year increase, PR, 2.23; 95% CI, 1.99-2.51), current weight (PR, 1.10; 95% CI, 1.06-1.14), and reporting 1 (PR, 1.78; 95% CI, 1.14-2.77), 2 (PR, 1.91; 95% CI, 1.16-3.15), or ≥3 knee injuries (PR, 3.44; 95% CI, 2.33-5.09) were associated with knee replacement. Age (10-year increase, PR, 1.86; 95% CI, 1.59-2.18), linemen (PR, 1.62; 95% CI, 1.03-2.55), and reporting 1 (PR, 1.72; 95% CI, 1.05-2.80), 2 (PR, 2.77 95% CI, 1.58-4.84), or ≥3 (PR, 2.44; 95% CI, 1.52-3.91) hip injuries were associated with hip replacement. Each reported knee injury type was cross-sectionally associated with replacement after retirement (P < .05).CONCLUSION: Knee replacement was more prevalent than hip replacement. Risk factors differed between the hip and the knee, with age and severe joint injury associated with hip and knee replacement, weight with knee replacement, and playing position associated with hip replacement. Joint injury and weight management may be prevention opportunities to reduce morbidity and end-stage osteoarthritis in this population.

U2 - 10.1177/0363546519870804

DO - 10.1177/0363546519870804

M3 - Article

VL - 47

SP - 2863

EP - 2870

JO - The American Journal of Sports Medicine

JF - The American Journal of Sports Medicine

SN - 0363-5465

IS - 12

ER -