Predictors of total hip replacement in community based older adults: a cohort study

V Mezhov,L.L Laslett,H Ahedi,C.L Blizzard,R.M Aspden,J.S Gregory,F.R Saunders,I.P Munugoda,G Cai,F Cicuttini,S.E Graves,M Lorimer,G Jones

doi:10.1016/j.joca.2021.04.013

Abstract

The purpose of this study is to describe predictors of total hip replacement (THR) in community dwelling older adults. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. At baseline, participants had assessment of radiographic OA and cam morphology (from pelvic radiographs), shape mode scores and hip bone mineral density (BMD; from dual energy X-ray absorptiometry (DXA)). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression. Incidence of THR for OA over 14 years was 4.6% (37/801). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.83/SD; 95% CI 1.1-3.04), shape mode 4 score (non-spherical femoral head) (RR 0.59/SD; 95% CI 0.36-0.96), cam morphology (α>60°) (RR 2.2/SD; 95% CI 1.33-3.36), neck of femur BMD (RR 2.09/SD, 95% CI 1.48-2.94) and bone marrow lesions (BMLs) increased risk of THR (RR 7.10/unit; 95% CI 1.09-46.29). In addition to hip pain and radiographic hip OA, measures of hip shape, cam morphology, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR.

Highlights

Hip osteoarthritis (OA) is a common musculoskeletal condition that is a major contributor to disability globally.[1]
There was a trend for hip effusions to increase the risk of total hip replacement (THR) (RR 1.88/SD; 95% confidence intervals (CIs) 0.24 to 14.78)
In addition to hip pain and radiographic hip OA, measures of hip shape, cam impingement, bone mineral density (BMD) and bone marrow lesions (BMLs) independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR

Summary

Introduction

Hip osteoarthritis (OA) is a common musculoskeletal condition that is a major contributor to disability globally.[1]. No studies have reported on all these risk factors in the same population or community based populations and few have adjusted for pain and/or radiographic osteoarthritis. When they have the result for hip shape became negative making it uncertain if these risk factors are independent.[6] the aim of this study was to examine the effect of hip structural factors as risk factors for THR independent of hip pain and radiographic measures of hip OA in community dwelling older adults. There is no preventative treatment available and total hip replacement (THR) is offered for end stage disease. The purpose of this study is to describe predictors of THR in community dwelling older adults

Objectives

Methods

Results

Conclusion