Knee osteoarthritis in a chestnut farmer – Case Report

Antonio Argentino 1, 2  ,  
Department of Medical and Surgical Sciences, University of Bologna, Italy
School of Occupational Medicine, Italy
Ann Agric Environ Med 2017;24(1):148–150
Several studies have dealt with the issue of professional risk factors and onset of knee osteoarthritis (OA). In particular, occupational epidemiological studies have provided evidence that activities resulting in biomechanical overload may be linked with an increased risk of knee OA – also among farmers. To our knowledge, no cases of knee OA among chestnut farmers have been reported in the literature.

Case report:
We report the case of a 70-year-old Caucasian male who has worked for more than 50 years on a chestnut farm. In 2007, an X-ray and a MRI, performed after a workplace accident to his left knee, showed the presence of knee OA. His job required a range of repetitive tasks, such as squatting, kneeling, climbing, walking on sloping terrain, assuming uncomfortable postures, and lifting and carrying heavy loads for the great majority of the working day. All the aforementioned tasks are known occupational risk factors for knee OA. Regarding individual risk factors, at the time of the first diagnosis of knee OA, the worker was 64-years-old with a body mass index of 26.5 kg/m2. He reported no cases of arthritis among his relatives and no sports playing on his part. In addition, his medical history revealed the presence of two minor lumbar disc herniations and tendinitis of the long head of the biceps.

Considering the lack of major individual risk factors for knee OA, it is reasonable to suppose that five decades of exposure to biomechanical overload as a chestnut farmer was a relevant risk factor for the onset of the disease.

Antonio Argentino   
Department of Medical and Surgical Sciences, University of Bologna, Italy
1. Bennell KL, Hunter DJ, Hinman RS. Management of osteoarthritis of the knee. BMJ. 2012; 345:e4934.
2. Palmer KT. Occupational activities and osteoarthritis of the knee. Br Med Bull. 2012;102:147–70.
3. Walker-Bone K, Palmer KT. Musculoskeletal disorders in farmers and farm workers. Occup Med (Lond). 2002; 52(8):441–50.
4. Kirkhorn S, Greenlee RT, Reeser JC. The epidemiology of agriculture-related osteoarthritis and its impact on occupational disability. WMJ. 2003; 102(7):38–44.
5. Franklin J, Ingvarsson T, Englund M, Lohmander S. Association between occupation and knee and hip replacement due to osteoarthritis: a case-control study. Arthritis Res Ther. 2010; 12(3):R102.
6. Mattioli S, Gori D, Di Gregori V, Ricotta L, Baldasseroni A, Farioli A et al. PubMed search strings for the study of agricultural workers’ diseases. Am J Ind Med. 2013; 56(12):1473–81.
7. McWilliams DF, Leeb BF, Muthuri SG, Doherty M, Zhang W. Occupational risk factors for osteoarthritis of the knee: a meta-analysis. Osteoarthritis Cartilage. 2011; 19(7):829–39.
8. World Health Organization (WHO). Global Database on Body Mass Index: BMI classification. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed 28 April 2015.