Symptomatic knee osteoarthritis common among patients with fragility hip fracture, suggests study

A new study revealed a strikingly high prevalence of symptomatic knee osteoarthritis (SKOA) among patients with fragility hip fractures (FHFs). The findings published in The Journal of Arthroplasty highlights the urgent need for comprehensive care strategies to reduce fall risk and subsequent fractures in this population.

Knee osteoarthritis (OA) is a widespread degenerative condition that impacts mobility and balance, which elevates the likelihood of falls. When combined with osteoporosis, the risk of fragility fractures further escalates. Despite the well-documented impact of both conditions, the frequency of knee OA among patients with FHFs has remained largely unexplored so far.

This cross-sectional study analyzed data from 162 patients who had undergone surgical treatment for FHFs, with an average age of 79 years, 80.2% of whom were women. Diagnosis of knee OA followed the American College of Rheumatology criteria, with severity classified using the Kellgren–Lawrence system. Bone mineral density (BMD) was assessed at the lumbar spine and contralateral hip, and fall risk was measured using self-reported questionnaires.

The findings suggest that 66% of FHF patients were diagnosed with symptomatic knee OA, and among them, 21% had end-stage knee OA (ESKOA). Also, 47.1% of the patients with ESKOA had been recommended for knee OA surgery prior to experiencing a hip fracture by highlighting missed opportunities for intervention.

A strong correlation was observed between SKOA and increased fall risk. The patients with SKOA were significantly more likely to report multiple falls (P = 0.013) and express a high fall risk (P = 0.020). In addition, BMD data from 120 patients indicated that 68% had low bone mineral density (T-score ≤ -2.5) at the lumbar spine or contralateral hip.

The study highlighted the coexistence of these conditions where 45% of FHF patients had both SKOA and low BMD, while 20% presented a triad of SKOA, low BMD, and high fall risk. These findings highlight the compounded challenges faced by this population, who are at increased risk for subsequent fractures.

This study emphasized that a dual approach addressing both knee OA and osteoporosis is critical to preventing further complications. Early identification and treatment of SKOA, along with robust management of low BMD, could play a pivotal role in improving mobility, reducing fall risk, and ultimately improving patient outcomes.

Source:

Mekariya, K., Vanitcharoenkul, E., Chotiyarnwong, P., Adulkasem, N., & Unnanuntana, A. (2025). High prevalence of symptomatic knee osteoarthritis among patients who have fragility hip fractures. The Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2025.01.016