Abstract
BackgroundApproaches for the prevention and treatment of hip osteoarthritis (OA) remain limited. There are recent data suggesting that low birth weight (LBW) and preterm birth may be risk factors for hip osteoarthritis. This has the potential to change the current paradigm of hip osteoarthritis prevention by targeting early life factors. The aim of this review was to examine the available evidence for an association of LBW and preterm birth with hip OA. The potential cost implications associated with total hip arthroplasty were also evaluated.MethodsOvid Medline, EMBASE, and Cinahl were searched up until August 2017 using MeSH terms and key words. Methodological quality was evaluated using the National Heart Lung and Blood Institute (NHLBI) quality assessment tool. Qualitative evidence synthesis was performed to summarise the results. Bradford Hill’s criteria for causation including the temporal relationship, consistency, strength of the association, specificity, dose-response relationship, and analogy were used to assess the evidence for causation. Economic modelling was used to calculate the potential economic burden associated with LBW or preterm birth related total hip arthroplasty using Australian data from 2012 to 2015.ResultsFive studies, ranging from high to low quality, were included. Hip bone shape abnormalities examined included developmental hip dysplasia and immature hip, and hip osteoarthritis included osteophytes and total hip arthroplasty. A causal link between low birth weight or preterm birth and hip osteoarthritis was found. Of the 30,477 total hip arthroplasties performed for hip osteoarthritis in Australia in 2015, 5791 were estimated to be born preterm and 5273 with low birth weight. This equated to a potential total hip arthroplasty cost of AU$145,136,082 and AU$132,150,222 for these subgroups, respectively.ConclusionAvailable data suggest that low birth weight and preterm birth are associated with hip bone shape abnormalities and hip osteoarthritis requiring total hip arthroplasty, with a substantial associated financial burden. Given the current lack of effective treatment and prevention strategies for hip osteoarthritis, this offers a new avenue for reducing the future burden of hip osteoarthritis.
Highlights
Approaches for the prevention and treatment of hip osteoarthritis (OA) remain limited
We aimed to examine the available evidence for an association of low birth weight (LBW) and preterm birth with hip OA, and to examine the evidence for potential causation based on the Bradford Hill criteria
Given the huge burden associated with both hip OA and LBW and preterm birth, we considered the potential cost implications associated with total hip arthroplasty (THA)
Summary
Approaches for the prevention and treatment of hip osteoarthritis (OA) remain limited. Post-delivery, these infants demonstrate an altered hip position (with hip extension) compared with the position of intrauterine life (flexed and abducted hip) and this may contribute to an increased incidence or greater severity of acetabular dysplasia [15, 16] It is perhaps unsurprising, that LBW and preterm birth have been associated with the pathology of hip OA. As hip OA is a chronic long-term condition, to understand the risk factors and pathogenesis of hip OA we need to consider the stages of hip OA across the life-course from early changes in hip bone shape to established hip OA and end-stage joint disease requiring joint replacement surgery Without considering these earlier stages, trying to identify hip OA will not be helpful as the prevalence of hip OA in those aged < 40 years is very low
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