Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study.

Elaine W Chong,Robyn H Guymer,Yuanyuan Wang,Stephen Graves,Graham G Giles,Flavia M Cicuttini,Liubov D Robman,Galina A Makeyeva,Khin Zaw Aung,Florian Sennlaub

doi:10.1371/journal.pone.0137322

Abstract

Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003–2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001–2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00–1.49). Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25–12.02). The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured neck of femur may be due to an increased prevalence of fractures in those with poor central vision associated with the late complications of age-related macular degeneration.

Highlights

Hip osteoarthritis (OA) and fractured neck of femur (#NOF) are both major public health problems[1,2]
Age-related macular degeneration (AMD) prevalence of 20.6% for early, 12.9% for intermediate AMD and 0.6% for late AMD was comparable with the respective categories in the Melbourne population-based study on AMD prevalence[25]. 791 (3.8%) total hip replacement (THR) due to OA and 102 (0.5%) THR due to #NOF were identified
There were more females in the group with THR for #NOF (p

Summary

Introduction

Hip osteoarthritis (OA) and fractured neck of femur (#NOF) are both major public health problems[1,2]. #NOF is a common clinical problem in the elderly, for whom it is a major cause of morbidity and mortality[1], it accounted for a small percentage (4%) of all THR in Australia[5]. It is estimated that falls in the elderly lead to injury 60% of the time, most are minor (50%), but 1 in ten results in more serious injuries (5%) and fractures (5%). Hospital admission for these injuries are often the precipitating event in 40% of admissions to long term institutional care[6] and only half of those with a hip fracture regain the same degree of mobility that they had before[7]. The number of THR for the treatment for end-stage hip diseases has increased by 45% in the last decade, with 27,508 procedures performed in Australia, in 2012[5]

Methods

Results

Conclusion