Did Ancient Man Have Knee Arthritis?

by Chris Centeno, MD /

risk for knee arthritis

The number of people with knee arthritis has exploded since I was a kid. One of the ways we can find out if this is related to our modern, industrialized societies is by looking at the bones of our ancestors. Even though they had far more wear and tear because being active was needed to maintain life, did that cause knee arthritis to be commonplace, or is it more common now in our relatively cushy world?

Bone-on-Bone Knee Arthritis

Bone-on-bone knee arthritis means the protective cartilage has completely worn down, and the joint space between the two knee bones (distal femur and proximal tibia) has narrowed to the point where bone is touching bone. When no cartilage remains, this would be considered severe knee arthritis, and this is what researchers focused on in the study below.

Study Compares Modern and Ancient Knees

In the new study, 2,600 skeletons from as recently as 2015 and all the way back to 300–6,000 years ago were investigated. All skeletal remains were estimated to be from individuals who were age 50 and older. The remains were each placed into one of three groups: death 1976–2015, death 1905–1940, and Native American remains from 6000–300 BP (about 4000 BC to 1700 AD). Investigators looked for a specific finding that indicated the subjects, while living, had that bone-on-bone contact at the knee. Knee arthritis was determined based on the ivory-like polish on the bones—when the polish is present, this is called eburnated bone, and eburnation occurs in bone-on-bone contact.

The results were quite telling. Bone-on-bone knee arthritis was present in 16% of the most modern group (the 1976–2015 group). The group just prior to the mid-20th century (1905–1940) had the fewest subjects with knee arthritis, at just 6%, while the most ancient group came in at 8%. So what has happened in recent decades to cause our risks for knee arthritis to more than double, and can that answer help us avoid knee arthritis?

Let’s take a look at some possibilities.

What Else Could Be Increasing Our Risk for Knee Arthritis?

With more than half of knee arthritis patients in the U.S. being under the age of 65, and the study comparing skeleton groups in the same age category, clearly aging can’t fully explain the prevalence of knee arthritis today. Body mass index (BMI) variables were also accounted for in the study, so obesity by itself also can’t explain knee arthritis, though digging into the risk factors for obesity (see metabolic syndrome below) may give us a clue. Additionally, we also can’t completely chalk it up to genetics as our mid-20th-century relatives’ risk for knee arthritis was less than half of what ours is today.

There are many other lifestyle changes and medical “advances,” however, that have occurred in recent generations that studies have shown may be factors in the skyrocketing increase risk for knee arthritis and in knee arthritis diagnoses in the past six-plus decades. Let’s review.

Hypertension: A recent study suggested that the presence of hypertension may be a risk factor for knee arthritis. 

Metabolic syndrome: High blood pressure, early diabetes, and, yes, obesity are all indicators of metabolic syndrome, and it is prevalent in the American lifestyle today. The presence of metabolic syndrome has been shown to have an effect on cartilage by destabilizing its chemical matrix (its structure). increasing the risk for knee arthritis.

The low-fat, high-carb diet: The low-fat movement based on flawed science was off and running in 1956 when the American Heart Association recommended it on national TV. We now know a low fat, high-carb diet feeds metabolic syndrome and other diseases.

Sedentary lifestyle: Certain forms of exercise have been shown to not only keep joints healthy but also be beneficial when knee arthritis already exists.

Nonsteroidal anti-inflammatory drugs (NSAIDs): In the U.S., we are heavy consumers of NSAIDs (e.g., Aleve, Celebrex, Advil), despite the dangerous risks, for even the most minor pain and inflammation. Yet, NSAIDs have been shown to progress arthritis, making it worse over time, and in many cases, NSAIDs may not actually work that well for pain.

Steroid injections: Steroid injections are a significant risk factor for knee arthritis as steroids have a deadly effect on cartilage, and studies have also shown them to be ineffective at continuing to relieve pain.

Meniscus surgery: Meniscus surgery has been shown to stress knees, leading to knee arthritis.

The upshot? Looks like based on the results of this study, our modern world is harder on our joints than the world of our ancestors. That in and of itself is interesting as the ancient world was mighty physically rough on joints. However, sitting all day, eating processed high-glycemic foods, medications, steroid shots, and our modern surgery-happy insurance system seems to be even rougher!

Category: Knee, Latest News

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4 thoughts on “Did Ancient Man Have Knee Arthritis?

  1. William Lund

    Great article!! I have total confidence in your research that the osteoarthritis syndrome will be one that is eventually curable! Growing new cartilage faster and more economically feasible for the average person!

  2. Manmohan Singh Patti

    I have severe knee arthritis in my case it was playing field hockey and was over weight. My mistake was not building the muscles around the knee. Now I am going to the gym 5 days a week working on my knees I have seen considerable improvement and back to hockey still pain is there.
    Then the doctors did not help when I had key hole surgery found at later stage that they had shaved to much of the cartilage and removed they torn meniscus. Since then I have learnt a lot about the knee mechanics, I would never let the surgeons touch my knee. I would say they are few surgeons who know the mechanics of the knee and know what to do. I am waiting for a reliable gene growth of the cartilage
    Regards

    1. Regenexx Team Post author

      Manmohan,
      Avoiding surgery when there are better alternatives is always a good idea, as there are no spare parts. Strengthening the muscles around the knee is a good idea as the surgery you had would likely have left the knee unstable. But importantly the ligaments would have been rendered lax by removing the torn meniscus and sections of cartilage, and should be tightened up to avoid the progression of arthritis that results. Please see: https://regenexx.com/blog/knee-meniscus-surgery-increases-odds-knee-replacement/ and https://regenexx.com/blog/knee-tibial-rotation-test-for-loose-knee-ligaments-to-prevent-arthritis/

    2. Dr. Scott Davis

      I agree with your finding that the orthopedic scope surgery is a very common procedure for the last few decades. Had my surgeon used the same procedure Regenexx professionals perform to repair the damage instead of cutting off the damaged tissues, I believe the bone on bone damage would not happen. Once the cushion tissues are gone gone, it’s gone for good. It’s not possible to fix what is no longer there. Same thing with the replacement procedure. Once they amputate the knee joint, it’s done. As a young man of 61 years, the longevity of the knee replacement continues to absolutely make it a non starter for me. One doctor cuts off and out tissue that the knee requires to function properly. After a few years, a recommendation for a different doctor that “handles patients with arthritis and bone to bone damage ” is the prelude to : “Oh You need a new knee.”
      The recommendation must say, “I got mine, now you get yours.”
      This is the medical practice in America today, and I believe that it is wrong. The future is here, but not fully yet, like coming soon to a medical practice near you.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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