Factors predicting progression of hip osteoarthritis: a systematic review

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Purpose: The goal was to systematically review the literature on factors predictive for progression in patients with hip osteoarthritis (OA). Methods: A systematic search was done in Embase, Medline (OvidSP), Web-of-science, Cochrane library, PubMed publisher and Google scholar from origin until August 8th 2016. Reference lists of relevant articles were screened. Studies were included if they met the following criteria: 1. Studies had a cohort or case control design, 2. they studied the association between factors (patient variables, disease characteristics or chemical/imaging markers) and progression (measured clinically, radiologically or receiving total hip replacement, THR), 3. patients had reported complaints like pain, disability or stiffness of the hip, suspected or confirmed (radiological or clinical) to originate from hip OA, 4. follow-up was at least 1 year, 5. hip OA caused by specific conditions was excluded. Risk of bias was assessed independently by two reviewers using the QUIPS tool. If clinical heterogeneity was considered low, study results were pooled per factor. If pooling was considered not appropriate a best evidence synthesis was conducted. The best evidence synthesis was conducted as follows: associations were categorized as positive, negative or no association. The ranking of levels of evidence was formulated as 1. Strong evidence: consistent finding (≥ 75% of the studies showing the same association) in multiple studies with a low risk of bias in all domains of the QUIPS tool, 2. Moderate evidence: consistent findings (≥75% of the studies showing the same association) in multiple studies with a moderate of high risk of bias in one or more domains of the QUIPS tool, 3. Limited evidence: one study with a low risk of bias in all domains of the QUIPS tool or 2 studies with moderate of high risk of bias in one or more domains of the QUIPS tool, 4. Conflicting evidence: <75% of the studies showing the same association, 5. No evidence: No studies found. Results: We included 56 different articles, describing 147 different factors. Three studies were assessed as low risk of bias in all domains of the QUIPS tool. Seventy-nine factors were reported once (one study). The clinical heterogeneity of the studies describing the other 68 factors (reported more than once) was considered too large to conduct a meta-analysis. Therefore we conducted a best evidence synthesis, separately for each factor regarding clinical progression (C), radiological progression (R) or progression to THR (T). No strong evidence was found for any prognostic factor. Moderate evidence was found for more or faster progression in patients having comorbidity (C), a family history of OA (R), more pain at baseline (T), a lower global assessment reported by the patient at baseline (T), certain modes created by statistical shape modelling (T) and a higher K-L grade at baseline (T). Moderate evidence for no association with progression was found for female gender (T+C), longer duration of symptoms at baseline (T), BMI (R), Diabetes Mellitus (R), Forestier’s disease (R), NTX-I (R), higher age at baseline (C), employment (C), social support (C), living alone (C), concurrent knee pain (C), depression (C), quality of life at a baseline (C), use of pain medication (C), range of motion of internal and external hip rotation (C). Conclusions: No strong evidence was found for prognostic factors of the progress of hip OA. Moderate evidence for an association or for no association with progression was found for several factors, while conclusions for most factors were inconclusive.