Prevalence of knee osteoarthritis and associated risk factors in Saudi Arabia: a systematic review and meta-analysis

Abstract

Knee osteoarthritis (KOA) is a major cause of pain and functional limitation, particularly among older adults. In Saudi Arabia, prevalence estimates vary considerably across studies, and the overall burden remains unclear. This study aimed to estimate the pooled prevalence of clinical or symptomatic KOA in Saudi Arabia and examine associated factors. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to August 2026 for observational studies conducted in Saudi Arabia that reported the prevalence of clinically or symptomatically defined KOA and/or its associated risk factors. Studies based exclusively on radiographic or MRI definitions were excluded. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Prevalence estimates were pooled using a random-effects model with restricted maximum likelihood estimation. Seven cross-sectional studies involving 11,562 participants were included. Prevalence estimates varied widely, ranging from 13.0% to 79.33%. The pooled prevalence of clinical/symptomatic KOA was 32% (95% CI, 18%â€"51%); among community-based studies, it was 30% (95% CI, 15%â€"52%). Leave-one-out sensitivity analysis produced estimates close to 32% after exclusion of most individual studies, but the estimate decreased to approximately 24% when Kandasamy et al. (2024) was excluded. Clinical/symptomatic KOA represented a substantial health burden among the Saudi populations studied, with a pooled prevalence of 32%. Older age, female sex, previous knee injury or trauma, and higher BMI were the most consistently associated factors. Prevention and early recognition should address modifiable risks, particularly excess body weight and preventable knee injury.