Elbow osteoarthritis and occupational mechanical exposures: a systematic review and meta-analysis

Background Elbow osteoarthritis (OA) is a degenerative joint disease causing functional impairment and may be associated with occupational mechanical exposures. To date, no systematic review has examined this association. Aims The aim of this systematic review was to study the association between occupational mechanical exposures and elbow OA. Methods A systematic literature search was conducted across four databases based on PECOS (Population, Exposure, Comparison, Outcome, Study design) criteria. Exclusion of studies, data extraction, risk-of-bias assessments and evaluation of the level of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) were performed independently by two reviewers. For the prevalence of elbow, we conducted a meta-analysis. When evaluating the association, a narrative synthesis was conducted due to the heterogeneity of study methodologies. Results A total of 1842 articles were identified, of which 10 met the inclusion criteria. The meta-analysis showed a pooled prevalence of elbow OA of 31% (95% CI 17–48%) and 20% (95% CI 15–25%) among workers exposed to vibration and manual work, respectively. The odds ratios for elbow OA in workers exposed to vibration ranged from 1.9 (95% CI 0.7–4.9) to 5.1 (95% CI 1.3–20.5), while heavy manual work varied between 1.1 (95% CI 0.6–2.1) and 3.9 (95% CI 2.2–6.8). For all occupational mechanical exposures, the level of evidence was very low. Conclusions We found indications of associations between occupational mechanical exposures and elbow OA. Since the evidence was assessed as very low, further research, specifically longitudinal studies with objective exposure assessments, is highly warranted.