Development Of Hip Osteoarthritis Research Articles

Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial

BackgroundArthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to self-reported symptom improvement. In the context of surgical interventions with known contextual effects and no true sham comparator trials, it is important to ascertain outcomes that are less susceptible to placebo effects. The primary aim of this trial was to determine if study participants with FAI who have hip arthroscopy demonstrate greater improvements in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to participants who undergo physiotherapist-led management.MethodsMulti-centre, pragmatic, two-arm superiority randomised controlled trial comparing physiotherapist-led management to hip arthroscopy for FAI. FAI participants were recruited from participating orthopaedic surgeons clinics, and randomly allocated to receive either physiotherapist-led conservative care or surgery. The surgical intervention was arthroscopic FAI surgery. The physiotherapist-led conservative management was an individualised physiotherapy program, named Personalised Hip Therapy (PHT). The primary outcome measure was change in dGEMRIC score between baseline and 12 months. Secondary outcomes included a range of patient-reported outcomes and structural measures relevant to FAI pathoanatomy and hip osteoarthritis development. Interventions were compared by intention-to-treat analysis.ResultsNinety-nine participants were recruited, of mean age 33 years and 58% male. Primary outcome data were available for 53 participants (27 in surgical group, 26 in PHT). The adjusted group difference in change at 12 months in dGEMRIC was -59 ms (95%CI − 137.9 to - 19.6) (p = 0.14) favouring PHT. Hip-related quality of life (iHOT-33) showed improvements in both groups with the adjusted between-group difference at 12 months showing a statistically and clinically important improvement in arthroscopy of 14 units (95% CI 5.6 to 23.9) (p = 0.003).ConclusionThe primary outcome of dGEMRIC showed no statistically significant difference between PHT and arthroscopic hip surgery at 12 months of follow-up. Patients treated with surgery reported greater benefits in symptoms at 12 months compared to PHT, but these benefits are not explained by better hip cartilage metabolism.Trial registration detailsAustralia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015.

The association between statistical shape variations of the hip and the presence of a cartilage defect or labral tear on MRI in high-impact athletes

Purpose: Hip osteoarthritis (OA) is highly prevalent in older people and a leading cause of physical disability worldwide. Although the etiology of hip OA is multifactorial, recent evidence has demonstrated that bony hip morphologies, such as cam morphology and acetabular dysplasia, are associated with an increased risk of developing hip OA in the elderly. Other morphological variants might also pose a risk; statistical shape modeling (SSM) can be used to identify these variants by quantifying the whole radiographic hip shape.

Sex Steroids and Osteoarthritis: A Mendelian Randomization Study.

ObjectiveSex steroids are thought to contribute to the pathogenesis of osteoarthritis (OA). This study investigated the causal role of sex steroids in site- and sex-specific OA and risk of joint replacement surgery using the Mendelian randomization (MR) method.MethodsInstrumental variables for estradiol, dehydroepiandrosterone sulfate, testosterone (T), and dihydrotestosterone (DHT) were selected. We used the inverse variance weighting (IVW) approach as the main MR method to estimate causal effects based on the summary-level data for OA and joint replacement surgery from genome-wide association studies (GWAS).ResultsA positive causal association was observed between serum T level and risks of hip OA (odds ratio [OR]=1.558, 95% confidence interval [CI]: 1.193–2.034; P=0.001) and hip replacement (OR=1.013, 95% CI: 1.008–1.018; P=2.15×10−8). Serum DHT level was also positively associated with the risk of hip replacement (OR=1.011, 95% CI: 1.006–1.015; P=4.03×10−7) and had potential causality with hip OA (OR=1.398, 95% CI: 1.054–1.855; P=0.020).ConclusionsSerum T and DHT levels may play causal roles in the development of hip OA and contribute to the risk of hip replacement, although the underlying mechanisms require further investigation.

Association of Sports Participation With Osteoarthritis: A Systematic Review and Meta-Analysis.

Background:The association between participating in sport and osteoarthritis is not fully understood.Purpose:To investigate the association between osteoarthritis and participating in sports not listed in previous reviews: American football, archery, baseball, bobsleigh, curling, handball, ice hockey, shooting, skeleton, speed skating, and wrestling.Study Design:Systematic review; Level of evidence, 3.Methods:We searched 4 electronic databases and hand searched recent/in-press editions of relevant journals. The criteria for study selection were case-control studies, cohort studies, nested case-control studies, and randomized trials with a control group that included adults to examine the effect of exposure to any of the included sports on the development of osteoarthritis.Results:The search returned 6197 articles after deduplication. Nine studies were included in the final review, covering hip, knee, and ankle osteoarthritis. There were no studies covering archery, baseball, skeleton, speed skating, or curling. The 6 sports included in the review were analyzed as a collective; the results of the meta-analysis indicated that participation in the sports analyzed was associated with an increased risk of developing osteoarthritis of the hip (relative risk [RR] = 1.67 [95% confidence interval (CI), 1.15-2.41]; P = .04), knee (RR = 1.60 [95% CI, 1.23-2.08]; P < .001), and ankle (RR = 7.08 [95% CI, 1.24-40.51]; P = .03) as compared with controls. Meta-analysis suggested a significantly increased likelihood of developing hip osteoarthritis through participating in wrestling (RR = 1.78 [95% CI, 1.20-2.64]; P = .004) and ice hockey (RR = 1.70 [95% CI, 1.27-2.29]; P < .001), while there was no significant difference through participating in handball (RR = 2.50 [95% CI, 0.85-7.36]; P = .10). Likelihood of developing knee osteoarthritis was significantly increased in wrestling (RR = 2.22 [95% CI, 1.59-3.11]) and ice hockey (RR = 1.52 [95% CI, 1.18-1.96]; both P < .002). According to the meta-analysis, shooting did not have a significant effect on the RR of knee osteoarthritis as compared with other sports (RR = 0.43 [95% CI, 0.06-2.99]; P = .39).Conclusion:The likelihood of developing hip and knee osteoarthritis was increased for ice hockey and wrestling athletes, and the risk of developing hip osteoarthritis was increased for handball athletes. The study also found that participation in the sports examined, as a collective, resulted in an increased risk of developing hip, knee, and ankle osteoarthritis.

Variants of FOXO3 and RPA3 genes affecting IGF-1 levels alter the risk of development of primary osteoarthritis.

Pathologically high growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels in patients with acromegaly are associated with arthropathy. Several studies highlight the potential role of the GH/IGF-1 axis in primary osteoarthritis (OA). We aimed to disentangle the role of IGF-1 levels in primary OA pathogenesis. Patients from the Genetics osteoARthritis and Progression (GARP) Study with familial, generalized, symptomatic OA (n = 337, mean age: 59.8 ± 7.4 years, 82% female) were compared to Leiden Longevity Study (LLS) controls (n = 456, mean age: 59.8 ± 6.8 years, 51% female). Subjects were clinically and radiographically assessed, serum IGF-1 levels were measured, and 10 quantitative trait loci (QTL) in the FOXO3, IGFBP3/TNS3, RPA3, SPOCK2 genes, previously related to serum IGF-1 levels, were genotyped. Linear or binary logistic generalized estimating equation models were performed. Serum IGF-1 levels were increased in OA patients, with male patients exhibiting the strongest effect (males OR = 1.10 (1.04-1.17), P=0.002 vs females OR = 1.04 (1.01-1.07), P = 0.02). Independent of the increased IGF-1 levels, male carriers of the minor allele of FOXO3 QTL rs4946936 had a lower risk to develop hip OA (OR = 0.41 (0.18-0.90), P = 0.026). Additionally, independent of IGF-1 levels, female carriers of the minor alleles of RPA3 QTL rs11769597 had a higher risk to develop knee OA (OR = 1.90 (1.20-2.99), P = 0.006). Patients with primary OA had significantly higher IGF-1 levels compared to controls. Moreover, SNPs in the FOXO3 and RPA3 genes were associated with an altered risk of OA. Therefore, altered IGF-1 levels affect the development of OA, and are potentially the result of the pathophysiological OA process.

Constitutional morphological features and risk of hip osteoarthritis: a case–control study using standard radiographs

ObjectivesTo evaluate the risk of association with hip osteoarthritis (OA) of 14 morphological features measured on standard antero-posterior pelvis radiographs.MethodsA case–control study of 566 symptomatic unilateral hip OA cases and...

Prevalence of osteoarthritis features on MRI in high-impact athletes: the femoroacetabular impingement and hip osteoarthritis cohort study

Purpose: High-impact sporting activity may be associated with the development of hip osteoarthritis (OA). Features of early hip OA on magnetic resonance imaging (MRI) have not been reported in this population. Further, the association between hip-related symptoms and features of early hip OA is unknown. Therefore, we aimed to: 1) compare OA features on MRI in high-impact athletes with and without hip pain; and 2) evaluate associations between the International Hip Outcome Tool (iHOT33), Copenhagen Hip and Groin Outcome Score (HAGOS) and OA features.

Expression profile of matrix metalloproteinases in the labrum of femoroacetabular impingement.

AimsFemoroacetabular impingement (FAI) is a potential cause of hip osteoarthritis (OA). The purpose of this study was to investigate the expression profile of matrix metalloproteinases (MMPs) in the labral tissue with FAI pathology.MethodsIn this study, labral tissues were collected from four FAI patients arthroscopically and from three normal hips of deceased donors. Proteins extracted from the FAI and normal labrums were separately applied for MMP array to screen the expression of seven MMPs and three tissue inhibitors of metalloproteinases (TIMPs). The expression of individual MMPs and TIMPs was quantified by densitometry and compared between the FAI and normal labral groups. The expression of selected MMPs and TIMPs was validated and localized in the labrum with immunohistochemistry.ResultsOn MMP arrays, most of the targeted MMPs and TIMPs were detected in the FAI and normal labral proteins. After data normalization, in comparison with the normal labral proteins, expression of MMP-1 and MMP-2 in the FAI group was increased and expression of TIMP-1 reduced. The histology of the FAI labrum showed disorderly cell distribution and altered composition of thick and thin collagen fibres. The labral cells expressing MMP-1 and MMP-2 were localized and their percentages were increased in the FAI labrum. Immunohistochemistry confirmed that the percentage of TIMP-1 positive cells was reduced in the FAI labrum.ConclusionThis study established an expression profile of MMPs and TIMPs in the FAI labrum. The increased expression of MMP-1 and MMP-2 and reduced expression of TIMP-1 in the FAI labrum are indicative of a pathogenic role of FAI in hip OA development.Cite this article: Bone Joint Res. 2020;9(4):173–181.

Unpicking observational relationships between hip shape and osteoarthritis: hype or hope?

To review recent findings concerning the observational relationship between hip shape and hip osteoarthritis (HOA) and their shared genetic influences, and the potential for clinical application. Recent observational studies have strengthened the evidence that specific shape deformities, such as cam and acetabular dysplasia, are related to HOA. Statistical shape modelling has emerged as a method to measure hip shape holistically, with the added advantage that this can be applied to dual X-ray absorptiometry scan images. This has led to several additional aspects of hip shape variation being identified, such as a wider femoral neck and larger lesser trochanter, in association with HOA. Furthermore, this method has formed the basis of genetic studies identifying novel genetic influences on hip shape, several of which are shared with known genetic risk factors for HOA. Shared genetic influences of hip shape and HOA raise the possibility that hip shape plays a casual role in the development of HOA, justifying preventive approaches aiming to combat these adverse consequences.

Radiographic factors associated with hip osteoarthritis: a systematic review.

The purpose of this study was to outline factors that contribute to the appearance of hip osteoarthritis (OA). Secondarily, this study aims to describe radiographic factors that are associated with the progression of OA in the arthritic hip. Pubmed/MEDLINE and Embase were searched in November 2018 for radiographic risk factors for hip OA. All articles were eligible if they (i) were written in the English language and (ii) commented on OA as it relates to radiographic description, appearance or progression of OA. Demographic characteristics of the study cohort, definition of OA, baseline OA and factors for prediction or progression of OA were recorded. Nine articles were included in this review. A total of 3268 patients were analyzed across all studies. The mean age was 60.0 years (range 18–91.5). The most common descriptors for OA were dysplasia and cam impingement. Six of the nine articles found acetabular under-coverage to be associated with developing OA. Four articles found cam morphology to be an associated factor. Finally, four articles commented on the factors associated with the progression to more severe grades of OA, reporting exclusively on acetabular under-coverage, whereas only one reported on cam morphology to be associated. This systematic review found acetabular under-coverage followed by cam morphology to be strongly associated with both the development and progression of hip OA. These findings define patients at risk for developing hip OA and emphasize the importance of early awareness of future joint degeneration.

The Natural History of Femoroacetabular Impingement.

Structural hip abnormalities have long been suspected of causing hip osteoarthritis. The concept of deformity of the proximal femur as a cause of osteoarthritis (OA) started with description of the tilt deformity and progressed to the pistol grip, then eventually cam-type femoroacetabular impingement (FAI). Acetabular over-coverage or retroversion as a cause of impingement is commonly referred to as pincer-type FAI. The primary research question we asked was: what is the natural history of hips with FAI? We reviewed the literature to identify studies with cross-sectional and longitudinal evidence of the effect of FAI on the development of or association with hip OA. In cross-sectional and longitudinal natural history studies of hip OA, cam-type FAI has consistently shown an association with developing OA. In regard to pincer-type FAI, the data are less convincing with some studies suggesting an increased risk and others showing a protective effect of the acetabular over-coverage. It is clear that not all patients with cam FAI get OA but the altered anatomy does increase the relative risk of developing OA. Cam-type FAI is associated with the development of hip OA; however, there is no role for prophylactic surgery in the asymptomatic hip with the anatomy predisposing to FAI. Further interventional studies are needed to determine whether surgical correction of cam-type FAI in the symptomatic hip alters the natural history of the condition.

Computer tomography acquired hip angles and patient reported outcomes in patients with femoroacetabular impingement syndrome

Purpose: Patients with femoroacetabular impingement syndrome (FAIS) experience pain, decreased function and quality of life. Patients present with cam and/or pincer morphology in their hip joint. FAIS is diagnosed via imaging, clinical signs and symptoms. In large cohorts using radiological measures, cam morphology has been associated with later development of osteoarthritis (OA) of the hip while it is less certain how pincer morphology is related to development of OA. In the cohort studies, pincer morphology was quantified using the lateral center edge angle (CE) and the anterior CE angle. Pincer, defined this way, was not associated with development of OA. However, quantifying pincer only by these two angles may not give the full picture of pincer impingement and its relation to hip OA. Hence, further description of abnormal values in patients with FAIS could help investigate the pathogenesis of FAIS. Furthermore, associations between patient reported outcomes and the specific angles might highlight which radiological parameters affect outcomes experienced by the patients. Hence, the aims of the study were 1) to describe computer tomography (CT) acquired angles in patients with FAIS compared with reference values from the literature 2) to investigate the association between hip angles in patients with FAIS and the Copenhagen Hip and Groin Outcome Score (HAGOS) and if HAGOS scores differ between patients with hip angles above/below mean reference values. Methods: Patients were eligible for inclusion if they were scheduled for primary hip arthroscopic surgery for FAIS. The study was approved by the Central Denmark Region Committee on Biomedical Research Ethics (1-10-72-239-14) and the Danish Data Protection Agency (1-16-02-499-14). The CT images of the hip were acquired on a Philips Brilliance 64 (Philips Medical Systems, Best, the Netherlands) scanner with low-dose radiation. Furthermore, a single image through the femoral condyles was obtained to measure the femoral anteversion (FeAV). Data were transferred to a Philips Mx view station (Philips Medical Systems, Best, the Netherlands). On the reformatted images the alpha angle, the CE angle, the acetabular index (AI), the posterior acetabular sector angle (PASA), the anterior acetabular sector angle (AASA), the horizontal acetabular sector angle (HASA) and the acetabular anteversion (AcAV) was measured by an experienced musculoskeletal radiologist. All patients completed the HAGOS. Associations between patient reported outcomes and hip angles was tested with linear regression. Comparisons between HAGOS data above/below mean reference values of hip angles were performed with the Wilcoxons test for unpaired data. Results: Sixty patients aged 36 ±9, 63% females were included in the study. Hip angles (55 patients) and HAGOS scores (60 patients) are tabulated in Table 1. Hip angles were not associated with any of the HAGOS scores. Those patients with a higher FeAV, PASA and HASA than reference mean values had worse HAGOS scores compared to those with lower hip angles than reference mean values. Conclusions: Patients presented with a high FeAV angle and many patients had a low AI angle. There was no overall association between HAGOS scores and hip angles, but patients with a high FeAV, PASA and/or HASA had worse HAGOS scores. These angles should be further investigated in order to investigate the pathogenesis of FAIS and to investigate whether the angles are related to later development of hip OA. Table details: ∼ Healthy reference values from Valera et al. 2018 Arch Orthop Trauma Surg, Lepage-Saucier et al. 2014 Eur Radiol and Kierkegaard et al. 2017 Journal of Science and Medicine in Sport. ∗ For the acetabular index angle, it is %patients below the reference meanTable 1Hip angles and HAGOS scores.Patients (mean±standard deviation)Healthy reference values (mean±standard deviation) ∼%patients with scores higher than reference mean (number of pt.)Affected legAlpha51.7 ±9.653.3 ±13.138% (21)FeAV27.5 ±10.517 ±391% (50)CE33.1 ±5.635 ±640% (22)AI2.8 ±6.06 ±569% (38)*AASA59.2 ±6.663 ±631% (17)PASA94.9 ±6.8103 ±911% (6)HASA154.1 ±9.3165 ±942% (23)AcAV18.0 ±4.724 ±547% (26)HAGOSPain51 ±20100Symptoms47 ±17100Activities of daily living53 ±24100Sport34 ±18100Physical activities21 ±23100Quality of life31 ±15100 Open table in a new tab

Femoroacetabular impingement syndrome is associated with development of hip osteoarthritis within 10-years follow-up: Data from the check cohort

Femoroacetabular impingement syndrome is associated with development of hip osteoarthritis within 10-years follow-up: Data from the check cohort

Statistical shape modeling of femur shape variability in female patients with hip dysplasia.

Although increasing evidence suggests that abnormal femur geometry in developmental dysplasia of the hip (DDH) may contribute to intra-articular damage and the development of hip osteoarthritis, a comprehensive 3D description of femoral abnormalities in DDH remains incomplete. Statistical shape modeling (SSM) was used to quantify three-dimensional (3D) geometric variation among femurs in female patients with DDH and control subjects. SSM correspondence points (n = 8,192) were placed on each femur using a gradient descent energy function to derive mean DDH and control femoral shapes and principal component analysis (PCA) was then used to describe shape variation. PCA results were associated with common 2D radiographic measures of femur shape using general linear models. For patients with DDH, the first eight principal components (modes) captured 90.9% of the cumulative variance accounted for (VAF). Notably, mode 2 captured 23.6% VAF and described variation in femoral version, the neck-shaft angle, and femoral neck length, while mode 3 captured 16.4% VAF and described variation in femoral version, femoral head size, and femoral offset. SSM captured complex geometric deformities in DDH, which may not be fully described by 2D measures of the acetabulum and proximal femur alone. By determining the primary shape variations among femurs in cases of DDH, SSM may further understanding of pathologies on the femoral side of dysplastic hips, in context with more commonly recognized acetabular deformities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Three-dimensional femoral head coverage in the standing position represents that measured in vivo during gait.

Individuals with over- or under-covered hips may develop hip osteoarthritis. Femoral head coverage is typically evaluated using radiographs, and/or computed tomography (CT) or magnetic resonance images obtained supine. Yet, these static assessments of coverage may not provide accurate information regarding the dynamic, three-dimensional (3-D) relationship between the femoral head and acetabulum. The objectives of this study were to: (1) quantify total and regional 3-D femoral head coverage in a standing position and during gait, and (2) quantify the relationship between 3-D femoral head coverage in standing to that measured during gait. The kinematic position of the hip during standing and gait was measured in vivo for 11 asymptomatic morphologically normal subjects using dual fluoroscopy and model-based tracking of 3-D CT models. Percent coverage in the standing position and during gait was measured overall and on a regional basis (anterior, superior, posterior, inferior). Coverage in standing was correlated with that measured during gait. For total coverage, very little change in coverage occurred during gait (range: 35.0-36.7%; mean: 36.2%). Coverage at each time point of gait strongly correlated with coverage during standing (r = 0.929-0.989). The regions thought to play an important role in weight bearing (i.e. anterior, superior, posterior) were significantly correlated with coverage in standing during the stance phase. Our results suggest that coverage measured in a standing position is a good surrogate for coverage measured during gait. Clin. Anat. 31:1177-1183, 2018. © 2018 Wiley Periodicals, Inc.

Unravelling the hip pistol grip/cam deformity: Origins to joint degeneration

This article reviews a body of work performed by the investigators over 9 years that has addressed the significance of cam morphology in the development of hip osteoarthritis (OA). Early hip joint degeneration is a common clinical presentation and preexisting abnormal joint morphology is a risk factor for its development. Interrogating Hill's criteria, we tested whether cam-type femoroacetabular impingement leads to hip OA. Strength of association was identified between cam morphology, reduced range-of-movement, hip pain, and cartilage degeneration. By studying a pediatric population, we were able to characterize the temporality between cam morphology (occurring 1st) and joint degeneration. Using in silico (finite element) and in vivo (imaging biomarkers) studies, we demonstrated the biological plausibility of how a cam deformity can lead to joint degeneration. Furthermore, we were able to show a biological gradient between degree of cam deformity and extent of articular damage. However, not all patients develop joint degeneration and we were able to characterize which factors contribute to this (specificity). Lastly, we were able to show that by removing the cam morphology, one could positively influence the degenerative process (experiment). The findings of this body of work show consistency and coherence with the literature. Furthermore, they illustrate how cam morphology can lead to early joint degeneration analogous to SCFE, dysplasia, and joint mal-reduction post-injury. The findings of this study open new avenues on the association between cam morphology and OA including recommendations for the study, screening, follow-up, and assessment (patient-specific) of individuals with cam morphology in order to prevent early joint degeneration. Statement of significance: By satisfying Hill's criteria, one can deduct that in some individuals, cam morphology is a cause of OA. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3125-3135, 2018.

Dose-response relationship between cumulative physical workload and osteoarthritis of the hip \u2013 a meta-analysis applying an external reference population for exposure assignment

BackgroundThere is consistent evidence from observational studies of an association between occupational lifting and carrying of heavy loads and the diagnosis of hip osteoarthritis. However, due to the heterogeneity of exposure estimates considered in single studies, a dose-response relationship between cumulative physical workload and hip osteoarthritis could not be determined so far.MethodsThis study aimed to analyze the dose-response relationship between cumulative physical workload and hip osteoarthritis by replacing the exposure categories of the included studies with cumulative exposure values of an external reference population. Our meta-regression analysis was based on a recently conducted systematic review (Bergmann A, Bolm-Audorff U, Krone D, Seidler A, Liebers F, Haerting J, Freiberg A, Unverzagt S, Dtsch Arztebl Int 114:581–8, 2017). The main analysis of our meta-regression comprised six case-control studies for men and five for women. The population control subjects of a German multicentre case-control study (Seidler A, Bergmann A, Jäger M, Ellegast R, Ditchen D, Elsner G, Grifka J, Haerting J, Hofmann F, Linhardt O, Luttmann A, Michaelis M, Petereit-Haack G, Schumann B, Bolm-Audorff U, BMC Musculoskelet Disord 10:48, 2009) served as the reference population. Based on the sex-specific cumulative exposure percentiles of the reference population, we assigned exposure values to each category of the included studies using three different cumulative exposure parameters. To estimate the doubling dose (the amount of physical workload to double the risk of hip osteoarthritis) on the basis of all available case-control-studies, meta-regression analyses were conducted based on the linear association between exposure values of the reference population and the logarithm of reported odds ratios (ORs) from the included studies.ResultsIn men, the risk to develop hip osteoarthritis was increased by an OR of 1.98 (95% CI 1.20–3.29) per 10,000 tons of weights ≥20 kg handled, 2.08 (95% CI 1.22–3.53) per 10,000 tons handled > 10 times per day and 8.64 (95% CI 1.87–39.91) per 106 operations. These estimations result in doubling dosages of 10,100 tons of weights ≥20 kg handled, 9500 tons ≥20 kg handled > 10 times per day and 321,400 operations of weights ≥20 kg. There was no linear association between manual handling of weights at work and risk to develop hip osteoarthritis in women.ConclusionsUnder specific conditions, the application of an external reference population allows for the derivation of a dose-response relationship despite high exposure heterogeneities in the pooled studies.

The Prevalence of Cam and Pincer Morphology and Its Association With Development of Hip Osteoarthritis.

Synopsis Our understanding of femoroacetabular impingement syndrome is slowly improving. The number of studies on all aspects (etiology, prevalence, pathophysiology, natural history, treatment, and preventive measures) of femoroacetabular impingement syndrome has grown exponentially over the past few years. This commentary provides the latest updates on the prevalence of cam and pincer hip morphology and its relationship with development of hip osteoarthritis (OA). Cam and pincer morphology is highly prevalent in the general population and in this paper is presented for different subgroups based on age, sex, ethnicity, and athletic activity. Methodological issues in determining prevalence of abnormal hip morphology are also discussed. Cam morphology has been associated with development of hip OA, but the association between pincer morphology and hip OA is much less clear. Results from reviewed studies, as well as remaining gaps in literature on this topic, are critically discussed and put into perspective for the clinician. J Orthop Sports Phys Ther 2018;48(4):230-238. doi:10.2519/jospt.2018.7816.

Interleukin-17 and Toll-like Receptor 10 genetic polymorphisms and susceptibility to large joint osteoarthritis.

Primary osteoarthritis (OA) is the most common type of a joint disease. It has a polygenic risk inheritance pattern and affects older people. The etiology of this disease is not fully understood. The aim of this study was to investigate the associations between polymorphisms in pro-inflammatory interleukin-17 (IL17A and IL17F) and anti-inflammatory Toll-like Receptor 10 (TLR10) genes with the risk for development of advanced stage hip and knee primary OA in the Croatian population. A total of 500 OA patients and 597 controls were genotyped for IL17A SNP (rs2275913), IL17F SNPs (rs763780 and rs1889570), and TLR10 (rs11096957) genes. The allelic and genotypic frequencies of IL17F SNP (rs763780) showed statistically significant differences in comparisons of controls with hip-but not knee-OA patients. The major allele (T) of rs763780 was associated with the lower risk for developing hip OA (p = 7.9 × 10-4 , OR = 0.45, 95%CI = 0.27-0.74), whereas the minor allele (C) was associated with susceptibility to hip OA (p = 7.9 × 10-4 , OR = 2.24, 95%CI = 1.35-3.72). The genotype T/T was associated with the protection to hip OA (p = 3.9 × 10-4 , OR = 0.41, 95%CI = 0.24-0.70), and, lastly, the genotype T/C was associated with the higher risk to acquiring hip OA (p = 2.6 × 10-4 , OR = 2.50, 95%CI = 1.47-4.25). TLR10 SNP rs11096957 was found significantly associated with predisposition to hip OA (p = 0.04, OR = 1.41, 95%CI = 1.02-1.94) but not knee OA. Our findings suggest that hip OA in Croatian population might have a different genetic risk regarding the IL17 and TLR10 gene locus than knee OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1684-1693, 2018.

Effect of Moderate Treadmill Exercise on hip Osteoarthritis in Male and Female Wistar Rats

Background: Osteoarthritis (OA) is a slowly progressive degenerative disease characterized by gradual loss of articular cartilage. The influence of excessive running load on the development of knee OA was investigated in male Wistar rats. This study was done to test the sex-related difference in the risk of OA of the hip joint after moderate running exercise. M aterials and Methods: Forty male and female Wistar rats were randomly assigned to four equal groups (2 male and 2 female groups) in a same condition. Ten of each sex were selected as control groups and kept separately while running exercises were performed in remained 20 male and female rats using a motor treadmill to motivate rats to run daily distances of 1 km at 5 days/week within six weeks. The treadmill incline was zero. On day 43, all control and training animals were killed and the hip articular cartilage and its synovial layer were evaluated microscopically. R es ults: The appearance of hip articular cartilage was normal and similar in all male, female and also male running groups while female running group showed some changes. Obtained results showed a mild OA only in the female running group. There wasn’t seen synovitis in both male and female running groups in comparison with control groups (P>0.05). Conclusion: This study showed that the development of hip OA may be related to the sex differences as seen in the knee OA previously.