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Prevalence of and factors associated with osteoarthritis and pain in retired Olympians compared with the general population: part 1 – the lower limb
  1. Debbie Palmer1,2,
  2. Dale Cooper3,
  3. Jackie L Whittaker4,5,
  4. Carolyn Emery6,
  5. Mark E Batt7,8,
  6. Lars Engebretsen9,10,
  7. Patrick Schamasch11,
  8. Malav Shroff11,
  9. Torbjørn Soligard10,
  10. Kathrin Steffen9,
  11. Richard Budgett10
  1. 1 Edinburgh Sports Medicine Research Network, Institute for Sport PE and Health Sciences, The University of Edinburgh, Edinburgh, UK
  2. 2 School of Medicine, University of Nottingham, Nottingham, UK
  3. 3 School of Allied Health Professions, Keel University, Keele, UK
  4. 4 Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  5. 5 Arthritis Research Canada, Richmond, British Columbia, Canada
  6. 6 Sport Injury Prevention Research Centre, Faculty of Kinesiology and Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  7. 7 Nottingham University Hospitals NHS Trust, Nottingham, UK
  8. 8 Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Queen's Medical Centre, Nottingham, UK
  9. 9 Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  10. 10 Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
  11. 11 Medical Committee, World Olympians Association, Lausanne, Switzerland
  1. Correspondence to Dr Debbie Palmer, Edinburgh Sports Medicine Research Network, Institute for Sport, PE and Health Sciences, The University of Edinburgh, Edinburgh, UK; dpalmer{at}


Objectives This study aims (1) to determine the prevalence of lower limb osteoarthritis (OA) and pain in retired Olympians; (2) to identify factors associated with their occurrence and (3) to compare with a sample of the general population.

Methods 3357 retired Olympians (median 44.7 years) and 1735 general population controls (40.5 years) completed a cross-sectional survey. The survey captured demographics, general health, self-reported physician-diagnosed OA, current joint/region pain and injury history (lasting >1 month). Adjusted OR (aOR) compared retired Olympians with the general population.

Results The prevalence of (any joint) OA in retired Olympians was 23.2% with the knee most affected (7.4%). Injury was associated with increased odds (aOR, 95% CI) of OA and pain in retired Olympians at the knee (OA=9.40, 6.90 to 12.79; pain=7.32, 5.77 to 9.28), hip (OA=14.30, 8.25 to 24.79; pain=9.76, 6.39 to 14.93) and ankle (OA=9.90, 5.05 to 19.41; pain=5.99, 3.84 to 9.34). Increasing age and obesity were also associated with knee OA and pain. While the odds of OA did not differ between Olympians and the general population, Olympians with prior knee and prior hip injury were more likely than controls with prior injury to experience knee (1.51, 1.03 to 2.21 (Olympians 22.0% vs controls 14.5%)) and hip OA (4.03, 1.10 to 14.85 (Olympians 19.1% vs Controls 11.5%)), respectively.

Conclusions One in four retired Olympians reported physician-diagnosed OA, with injury associated with knee, hip and ankle OA and pain. Although overall OA odds did not differ, after adjustment for recognised risk factors Olympians were more likely to have knee and hip OA after injury than the general population, suggesting injury is an occupational risk factor for retired Olympians.

  • Osteoarthritis
  • Hip
  • Knee
  • Ankle
  • Sporting injuries

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Twitter @DebbiePalmerOLY, @jwhittak_physio, @CarolynAEmery, @larsengebretsen, @TSoligard

  • Contributors All authors contributed to the study conception and design, data collection and interpretation. DP analysed the data and drafted the paper. All authors provided revisions and contributed to the final manuscript. DP is the guarantor.

  • Funding The World Olympians Association funded the Retired Olympian Musculoskeletal Health Study (ROMHS) with a research grant from the International Olympic Committee (IOC).

  • Competing interests TS works as scientific manager in the Medical and Scientific Department of the IOC. LE is Head of Scientific Activities in the Medical and Scientific Depart of the IOC. LE is Editor and KS coeditor of the British Journal of Sports Medicine-Injury Prevention and Health Protection. RB is director of the Medical and Scientific Department of the IOC.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.