Hip Replacement For Osteoarthritis Research Articles

The Kinesin Gene KIF26B Modulates the Severity of Post-Traumatic Heterotopic Ossification.

The formation of pathological bone deposits within soft tissues, termed heterotopic ossification (HO), is common after trauma. However, the severity of HO formation varies substantially between individuals, from relatively isolated small bone islands through to extensive soft tissue replacement by bone giving rise to debilitating symptoms. The aim of this study was to identify novel candidate therapeutic molecular targets for severe HO. We conducted a genome-wide scan in men and women with HO of varying severity following hip replacement for osteoarthritis. HO severity was dichotomized as mild or severe, and association analysis was performed with adjustment for age and sex. We next confirmed expression of the gene encoded by the lead signal in human bone and in primary human mesenchymal stem cells. We then examined the effect of gene knockout in a murine model of osseous trans-differentiation, and finally we explored transcription factor phosphorylation in key pathways perturbed by the gene. Ten independent signals were suggestively associated with HO severity, with KIF26B as the lead. We subsequently confirmed KIF26B expression in human bone and upregulation upon BMP2-induced osteogenic differentiation in primary human mesenchymal stem cells, and also in a rat tendo-Achilles model of post-traumatic HO. CRISPR-Cas9 mediated knockout of Kif26b inhibited BMP2-induced Runx2, Sp7/Osterix, Col1A1, Alp, and Bglap/Osteocalcin expression and mineralized nodule formation in a murine myocyte model of osteogenic trans-differentiation. Finally, KIF26B deficiency inhibited ERK MAP kinase activation during osteogenesis, whilst augmenting p38 and SMAD 1/5/8 phosphorylation. Taken together, these data suggest a role for KIF26B in modulating the severity of post-traumatic HO and provide a potential novel avenue for therapeutic translation.

Does weight loss reduce the incidence of total knee and hip replacement for osteoarthritis?\u2014A prospective cohort study among middle-aged and older adults with overweight or obesity

ObjectiveThis study aims to investigate the association between weight change and total knee or hip replacement (TKR or THR) for OA among middle-aged and older adults with overweight or obesity.MethodWeight data were collected in 2006–2009 and in 2010 from the 45 and Up Study—a population-based cohort aged ≥45 years in New South Wales, Australia. Participants were included if they had a baseline body mass index (BMI) ≥ 25 kg/m2 and no history of TKR or THR. Weight change was categorised into four groups: >7.5% loss; >5–7.5% loss; stable (≤5% change) and >5% gain. Hospital admission data were linked to identify TKR and THR for OA, and multivariable Cox regression was used to assess risk of TKR and THR.ResultsOf 23,916 participants, 2139 lost >7.5% weight, 1655 lost 5–7.5% weight, and 4430 gained >5% weight. Over 5.2 years, 1009 (4.2%) underwent TKR and 483 (2.0%) THR. Compared to weight-stable, weight loss of >7.5% was associated with reduced risk of TKR after adjusting for age, sex, BMI, socioeconomic and lifestyle factors (hazard ratio 0.69, 95%CI 0.54–0.87), but had no association with THR. Weight loss of 5–7.5% was not associated with altered risk of either TKR or THR. Weight gain was associated with increased risk of THR after adjusting for confounders, but not TKR.ConclusionThis study suggests that a weight loss target >7.5% is required to reduce the risk of TKR in adults with overweight or obesity. Weight gain should be avoided as it increases the risk of THR.

Association between circulating 25-hydroxyvitamin D concentrations and hip replacement for osteoarthritis: results from a prospective cohort study

Association between circulating 25-hydroxyvitamin D concentrations and hip replacement for osteoarthritis: results from a prospective cohort study

Does weight loss reduce the incidence of total knee and hip replacement for osteoarthritis? - a prospective cohort study among older adults with overweight or obesity

Purpose: Current international guidelines recommend 5-7.5% weight-loss for patients with osteoarthritis (OA) and concurrent overweight or obesity. However, the impact of weight loss on the long-term progression of OA remains unclear. The aim of this study is to investigate the association between weight change and total knee replacement (TKR) or total hip replacement (THR) for OA among older adults with overweight or obesity.

The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030

BackgroundComprehensive national joint replacement registries with well-validated data offer unique opportunities for examining the potential future burden of hip and knee osteoarthritis (OA) at a population level. This study aimed to forecast the burden of primary total knee (TKR) and hip replacements (THR) performed for OA in Australia to the year 2030, and to model the impact of contrasting obesity scenarios on TKR burden.MethodsDe-identified TKR and THR data for 2003–2013 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population projections and obesity trends were obtained from the Australian Bureau of Statistics, with public and private hospital costs sourced from the National Hospital Cost Data Collection. Procedure rates were projected according to two scenarios: (1) constant rate of surgery from 2013 onwards; and (2) continued growth in surgery rates based on 2003–2013 growth. Sensitivity analyses were used to estimate future TKR burden if: (1) obesity rates continued to increase linearly; or (2) 1–5% of the overweight or obese population attained a normal body mass index.ResultsBased on recent growth, the incidence of TKR and THR for OA is estimated to rise by 276% and 208%, respectively, by 2030. The total cost to the healthcare system would be $AUD5.32 billion, of which $AUD3.54 billion relates to the private sector. Projected growth in obesity rates would result in 24,707 additional TKRs totalling $AUD521 million. A population-level reduction in obesity could result in up to 8062 fewer procedures and cost savings of up to $AUD170 million.ConclusionsIf surgery trends for OA continue, Australia faces an unsustainable joint replacement burden by 2030, with significant healthcare budget and health workforce implications. Strategies to reduce national obesity could produce important TKR savings.

Fuctional outcome of primary total hip replacement in osteoarthritis of HIP

Introduction: Osteoarthritis is the most common disorder associated with severe hip pain and disability in adult and elderly population. Total hip replacement (THR) has been termed as “the operation of the century” as it has revolutionised management of elderly patients crippled with arthritis, with very good long term results. Replacement of damaged cartilage surfaces with various artificial bearing materials has enabled surgeons to improve function and relieve pain in vast majority of patients [1]. At present THR is most commonly performed adult reconstructive hip procedure. The intend of the study was to evaluate the clinical as well as functional outcome of primary total hip replacement using modified harris hip score. All the patients were operated using posterior moore’s approach which is commonly employed in our institution.Materials and Methods: A prospective study of 20 hips (20 patients) with primary or secondary osteoarthritis above the age of 30 years managed by both cemented and uncemented total hip replacement at basaveshwara teaching and general hospital attached to M.R Medical college kalaburagi from June 2016 to May 2018 were studied. Patient follow up was for a minimum period of 6 months.Results: Patients were evaluated both functionally and radiologically. Functional evaluation with Modified Harris hip score showed excellent results in 12 hips, good in 6 hips, fair in 2 hips. We had complications in 3 patients, superficial infection in 1 patient and posterior dislocation in 2 patients. No poor results were noted. Radiological evaluation at the latest follow up of all cases showed no signs of aseptic loosening or implants failure.Conclusion: Our study suggests that primary total hip replacement provides excellent functional outcome in osteoarthritis of hip. Though the study was not free of complications, the overall functional outcome showed good results and thus it confirmed the proven efficacy of total hip replacement in treatment of osteoarthritis.

Prospective associations of C-reactive protein (CRP) levels and CRP genetic risk scores with risk of total knee and hip replacement for osteoarthritis in a diverse cohort

To examine associations of high-sensitivity C-reactive protein (CRP) levels and polygenic CRP genetic risk scores (GRS) with risk of end-stage hip or knee osteoarthritis (OA), defined as incident total hip (THR) or knee replacement (TKR) for OA. This study included a cohort of postmenopausal white, African American, and Hispanic women from the Women's Health Initiative. Women were followed from baseline to date of THR or TKR, death, or December 31, 2014. Medicare claims data identified THR and TKR. Hs-CRP and genotyping data were collected at baseline. Three CRP GRS were constructed: 1) a 4-SNP GRS comprised of genetic variants representing variation in the CRP gene among European populations; 2) a multilocus 18-SNP GRS of genetic variants significantly associated with CRP levels in a meta-analysis of genome-wide association studies; and 3) a 5-SNP GRS of genetic variants significantly associated with CRP levels among African American women. In analyses conducted separately among each race and ethnic group, there were no significant associations of ln hs-CRP with risk of THR or TKR, after adjusting for age, body mass index, lifestyle characteristics, chronic diseases, hormone therapy use, and non-steroidal anti-inflammatory drug use. CRP GRS were not associated with risk of THR or TKR in any ethnic group. Serum levels of ln hs-CRP and genetically-predicted CRP levels were not associated with risk of THR or TKR for OA among a diverse cohort of women.

General and Abdominal Obesity as Risk Factors for Late-Life Mobility Limitation After Total Knee or Hip Replacement for Osteoarthritis Among Women.

To investigate associations of body mass index (BMI), waist circumference (WC), and waist/hip ratio (WHR) with survival to age 85 years with mobility limitation or death before age 85 years among older women with total knee replacement (TKR) or total hip replacement (THR) for osteoarthritis (OA). This was a prospective study of women (ages 65-79 years at baseline) from the Women's Health Initiative, recruited during 1993-1998 and followed through 2012. Women's Health Initiative data were linked to Medicare claims data to determine TKR (n = 1,867) and THR (n = 944) for OA. Women were followed for up to 18 years after undergoing THR or TKR to determine mobility status at age 85 years. Compared with normal-weight women, overweight, obese I, and obese II women with THR had significantly increased risk of survival to age 85 years with mobility limitation (P < 0.001 for linear trend), with the strongest risk among obese II women (odds ratio [OR] 4.37 [95% confidence interval (95% CI) 1.96-9.74]). Obese II women with THR also had increased risk of death before age 85 years. Women with THR and WC >88 cm relative to ≤88 cm had increased risk of survival to age 85 years with mobility limitation (OR 1.65 [95% CI 1.17-2.33]) but not death before age 85 years. High BMI, WC, and WHR were associated with significantly increased risk of late-life mobility limitation and death among women with TKR for OA. Among older women who underwent THR or TKR for OA, baseline general and abdominal obesity were associated with increased risk of late-life mobility limitation.

An evaluation of survival modelling approaches for personalised risk prediction after hip replacement for osteoarthritis

Purpose: The development of an algorithm that provides accurate individualised estimates of revision risk could help patients make informed and preference-based surgical treatment choices. This necessitates the choice of an appropriate survival model that takes fixed and modifiable risk factors and predicts the outcome at the individual level. The purpose of the present study was to compare different survival models for predicting prosthesis survivorship after hip replacement for osteoarthritis using data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR). Methods: In this comparative study we implemented parametric and flexible parametric (FP) methods and random survival forests (RSF). Predictors examined included age, BMI, sex, ASA physical status, anaesthetic, chemical and mechanical thromboprophylaxis, surgical approach, operation type (unilateral/ same-day bilateral), fixation and bearing types. The overall performance of the parametric models was compared using Akaike information criterion (AIC). For each model, the average of predicted survival curves over all individuals were compared with the observed values. The preferred parametric model and the RSF algorithm were further compared in terms of overall performance (integrated Brier score), discrimination capability (concordance index) and calibration via repeated five-fold cross-validation. Results: The dataset contains 327 238 hip replacements for osteoarthritis carried out in England and Wales between 2003 and 2015. The AIC value for the FP model was the lowest (Exponential model: 57515; Weibull model: 55494; Log-logistic model: 55494; FP model: 55118). The averages of survival probability estimates were in good agreement with the observed values for the FP model and the RSF algorithm as shown in Fig. 1. The integrated Brier score of the FP model and the RSF approach over 10 years were similar: 0.011 (95% confidence interval: 0.011-0.011). The concordance index of the FP model at 10 years was 59.4% (95% confidence interval: 59.4%-59.4%). This was 56.2% (56.1%-56.3%) for the RSF method. Calibration plots for the FP model and the RSF algorithm are presented in Fig. 2. The average observed-to-predicted ratios for the FP model and RSF approach were 0.99 and 1.34, respectively.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Conclusions: The accuracy of individual prediction for prosthesis failure after THA for osteoarthritis is modest using administrative demographic and operative data and a single model to describe the variance associated with a compound outcome endpoint. The flexible parametric model outperformed other commonly used survival models across chosen validation criteria. However, it still does not provide a high discriminatory power at the individual level. This might be due to variable outcomes generated by different fixation or bearing types that cannot be captured using a single model. More complex multi-state models may provide better discrimination.

Reduced Sirtuin1 expression at the femoral neck in women who sustained an osteoporotic hip fracture.

To investigate the role of Sirtuin1 in osteoporosis, Sirtuin1 was determined at the femoral neck in female patients undergoing hip operation for fractured hip or osteoarthritis. Reduced Sirtuin1 was found in osteoporotic patients. Pharmacologic activation of Sirtuin1 reduced sclerostin, an inhibitor of bone formation. Activation of Sirtuin1 may be a new direction to generate therapies for osteoporosis. The aim of the study are to investigate the role of Sirtuin1 (Sirt1), an anti-aging factor and a player in age-associated diseases, in osteoporotic hip fractures, and test the hypothesis that Sirt1 is a negative regulator of sclerostin, a bone formation inhibitor, in human femoral bone marrow mesenchymal cells (BM-MSCs). Sirt1 and sclerostin were determined by western blot in bone samples obtained intra-operatively from the inferior medial cortex of the femoral neck (calcar region) in female patients undergoing partial hip replacement for fractured neck of femur (N = 10) or hip replacement for osteoarthritis (N = 8) (mean ± SD age 81 ± 8.1 vs. 68 ± 9.3years; BMI 26.2 ± 3.6 vs. 25.9 ± 7.1kg/m(2) in osteoporotic and osteoarthritis patients). Calcar thickness and femoral bone mineral density (BMD) were determined preoperatively by X-ray using a digital TraumaCad(™) software and DEXA. Femoral BM-MSCs were collected intra-operatively and treated with SRT3025, a Sirt1 activator. Sclerostin and dentin matrix acidic phosphoprotein (DMP1)were determined by western blot and messenger RNA (mRNA) expression of Lef1 and DMP1 was evaluated byquantitative real-time PCR. Osteoporotic (OP) patients had reduced cortical thickness, femoral neck, and total hip BMD compared to osteoarthritis (OA) patients. Calcar Sirt1 expression was significantly reduced, while sclerostin was markedly increased in OP compared to OA patients. Sirt1 and sclersotin expressions were inversely correlated (r = -0.49, P = 0.047). SRT3025 administration down-regulated sclerostin and up-regulated DMP1 protein level and increased LEF1 and DMP1 mRNA expressions in OP patient-derived BM-MSCs. Reduced femoral neck Sirt1 may play a role in osteoporotic hip fractures in part via influencing local sclerostinexpression. The therapeutic potential of Sirt1 activation in osteoporosis warrants further investigation.

Impact of impaired health-related quality of life and obesity on the risk of knee and hip replacement for osteoarthritis

Impact of impaired health-related quality of life and obesity on the risk of knee and hip replacement for osteoarthritis

Association of low birth weight and preterm birth with the incidence of knee and hip arthroplasty for osteoarthritis.

Low birth weight (LBW) and preterm birth have been associated with adverse adult outcomes, including hypertension, insulin resistance, cardiovascular disease, and reduced bone mass. It is unknown whether LBW and preterm birth affect the risk of osteoarthritis (OA). This study aims to examine whether LBW and preterm birth were associated with the incidence of knee and hip arthroplasty for OA. A total of 3,604 participants of the Australian Diabetes, Obesity and Lifestyle Study who reported their birth weight and history of preterm birth and were age >40 years at the commencement of arthroplasty data collection comprised the study sample. The incidence of knee and hip replacement for OA during 2002-2011 was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. One hundred and sixteen participants underwent knee arthroplasty and 75 underwent hip arthroplasty for OA. LBW (yes versus no; hazard ratio [HR] 2.04, 95% confidence interval [95% CI] 1.11-3.75, P = 0.02) and preterm birth (yes versus no; HR 2.50, 95% CI 1.29-4.87, P = 0.007) were associated with increased incidence of hip arthroplasty independent of age, sex, body mass index, education level, hypertension, diabetes mellitus, smoking, and physical activity. No significant association was observed for knee arthroplasty. Although these findings will need to be confirmed, they suggest that individuals born with LBW or at preterm are at increased risk of hip arthroplasty for OA in adult life. The underlying mechanisms warrant further investigation.

Total hip replacement in osteoarthritis: the role of bone metabolism and its complications.

Osteoarthritis is one of the most common joint disorder. For treatment of hip symptomatic osteoarthritis, when conservative medical therapy has failed, total hip arthroplasty (THA) is a successful orthopaedic procedures that reduces pain and improves function and quality of life. Incidence of osteoarthritis is constantly increasing with raising life expectancy. This aging process also has led to an increasing number of patients with osteoporosis who need hip replacement for osteoarthritis. Osteoporosis have 3 major potential complications in total hip arthroplasty: perioperative fracture, an increased risk of periprosthetic fracture, and late aseptic loosening. The purpose of the present study was to examine the effects of osteoporosis on total hip replacement procedure outcome and highlight the importance of adequate study of calcium-phosphorus metabolism in patient candidate for hip surgery, and the need to start a suitable therapy to recover the bone mass before surgery. Bone quality of the hip joint has become an important risk factor limiting the durability of THA.

Incidence of Total Knee and Hip Replacement for Osteoarthritis in Relation to Circulating Sex Steroid Hormone Concentrations in Women

The increased prevalence of osteoarthritis (OA) in postmenopausal women suggests that changes in either circulating sex steroid concentrations or the tissue response to sex steroids may have a role in the pathogenesis of OA. The aim of this study was to examine whether circulating sex steroid concentrations are associated with the incidence of total knee and total hip replacement for OA. Study subjects (n = 2,621; all women) were recruited in 1990-1994 from the Melbourne Collaborative Cohort Study (MCCS). Circulating sex steroid concentrations were measured in blood samples obtained from the women at the time of recruitment. The incidence of total knee and total hip replacement for OA during 2001-2011 was determined by linking the MCCS records to the Australian Orthopaedic Association National Joint Replacement Registry. During the followup period, 115 women had undergone total knee replacement and 99 had undergone total hip replacement for OA. Greater log-transformed concentrations of estradiol were associated with a lower incidence of knee replacement (hazard ratio [HR] 0.70, 95% confidence interval [95% CI] 0.50-0.96), and greater log-transformed concentrations of androstenedione were associated with a lower incidence of hip replacement (HR 0.70, 95% CI 0.52-0.93). In contrast, greater log-transformed concentrations of sex hormone binding globulin (SHBG) were associated with a higher incidence of hip replacement (HR 1.70, 95% CI 1.05-2.77). A lower estradiol concentration is a risk factor for knee OA, while a lower androstenedione concentration and higher SHBG concentration are risk factors for hip OA in women. These findings suggest that circulating sex steroids have a role in the pathogenesis of OA, and that modifying these steroid concentrations may provide a potential strategy for the prevention and treatment of knee and hip OA.

Association of low birth weight and preterm birth with the incidence of knee and hip arthroplasty for osteoarthritis

Objective Low birth weight (LBW) and preterm birth have been associated with adverse adult outcomes, including hypertension, insulin resistance, cardiovascular disease, and reduced bone mass. It is unknown whether LBW and preterm birth affect the risk of osteoarthritis (OA). This study aims to examine whether LBW and preterm birth were associated with the incidence of knee and hip arthroplasty for OA. Methods A total of 3,604 participants of the Australian Diabetes, Obesity and Lifestyle Study who reported their birth weight and history of preterm birth and were age >40 years at the commencement of arthroplasty data collection comprised the study sample. The incidence of knee and hip replacement for OA during 2002–2011 was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Results One hundred and sixteen participants underwent knee arthroplasty and 75 underwent hip arthroplasty for OA. LBW (yes versus no; hazard ratio [HR] 2.04, 95% confidence interval [95% CI] 1.11–3.75, P = 0.02) and preterm birth (yes versus no; HR 2.50, 95% CI 1.29–4.87, P = 0.007) were associated with increased incidence of hip arthroplasty independent of age, sex, body mass index, education level, hypertension, diabetes mellitus, smoking, and physical activity. No significant association was observed for knee arthroplasty. Conclusion Although these findings will need to be confirmed, they suggest that individuals born with LBW or at preterm are at increased risk of hip arthroplasty for OA in adult life. The underlying mechanisms warrant further investigation.

Incidence of total knee and hip replacement for osteoarthritis in relation to the metabolic syndrome and its components: A prospective cohort study

Incidence of total knee and hip replacement for osteoarthritis in relation to the metabolic syndrome and its components: A prospective cohort study

Incidence of total knee and hip replacement for osteoarthritis in relation to the metabolic syndrome and its components: A prospective cohort study

ObjectiveTo examine whether components of metabolic syndrome (MetS), either singly or additively, were associated with the incidence of severe knee and hip OA, and whether these associations were independent of obesity assessed by body mass index (BMI). MethodsTwenty thousand, four hundred and thirty participants who had blood lipids, anthropometric and blood pressure measurements during 2003–2007 were selected from the Melbourne Collaborative Cohort Study. MetS was defined as central obesity assessed by waist circumference and any two of raised triglyceride level, reduced HDL cholesterol level, hypertension or impaired fasting glycaemia. The incidence of total knee and hip replacement was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. ResultsSix hundred and sixty participants had knee OA and 562 had hip OA. After adjustment for age, gender, country of birth, education, physical activity and BMI, central obesity [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.25–2.01] and hypertension (1.24, 1.05–1.48) were associated with increased risk of knee OA. The accumulation of MetS components was associated with knee OA risk, independent of BMI: one component, 2.12 (1.15–3.91); two components, 2.92 (1.60–5.33) and three or more components, 3.09 (1.68–5.69). No statistically significant associations were observed for hip OA. ConclusionCumulative number of MetS components and central obesity and hypertension were associated with increased risk of severe knee OA, independent of BMI. No associations were observed with severe hip OA. These findings suggest that the pathogenesis of knee and hip OA differ and that targeting the management of MetS may reduce the risk of knee OA.

How Patient Centered Are Medical Decisions?

Informing and involving patients in their medical decisions is increasingly becoming a standard for good medical care, particularly for primary care physicians. To learn how patients describe the decision-making process for 10 common medical decisions, including 6 that are most often made in primary care. A survey of a national sample of adults 40 years or older who in the preceding 2 years had either experienced or discussed with a health care provider 1 or more of 10 decisions: medication for hypertension, elevated cholesterol, or depression; screening for breast, prostate, or colon cancer; knee or hip replacement for osteoarthritis, or surgery for cataract or low back pain. Adults living in households in the United States in 2011. A national sample of adults drawn from a probability sample-based web panel developed by Knowledge Networks. Patients' perceptions of the extent to which the pros and cons were discussed with their health care providers, whether the patients were told they had a choice, and whether the patients were asked for their input. Responses were obtained from 2718 patients, with a response rate of 58.3%. Respondents reported much more discussion of the pros than the cons of all tests or treatments; discussions about the surgical procedures tended to be more balanced than those about medications to reduce cardiac risks and cancer screening. Most patients (60%-78%) said they were asked for input for all but 3 decisions: medications for hypertension and elevated cholesterol and having mammograms (37.3%-42.7%). Overall, the reported decision-making processes were most patient centered for back or knee replacement surgery and least for breast and prostate cancer screening. Discussions about these common tests, medications, and procedures as reported by patients do not reflect a high level of shared decision making, particularly for 5 decisions most often made in primary care.

Body weight at early and middle adulthood, weight gain and persistent overweight from early adulthood are predictors of the risk of total knee and hip replacement for osteoarthritis

To examine the relationships between weight at early and middle adulthood and adult weight gain and the risk of total knee and hip replacement for OA. At baseline interview during 1990-94, 38,149 participants [mean age 54.9 (S.D. 8.6) years] of the Melbourne Collaborative Cohort Study were asked to recall their weight at age 18-21 years and had their middle age height and weight measured. Total knee and hip replacement for OA between 2001 and 2009 was determined by linking the cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Greater weight and BMI at age 18-21 years and middle age, weight gain and persistent overweight during this time were associated with an increased risk of total knee and hip replacement. Middle age weight [hazard ratio (HR) per 5 kg 1.25 (95% CI 1.23, 1.27) for knee vs 1.11 (1.09, 1.14) for hip] and BMI [HR per 5 kg/m(2) 1.80 (1.72, 1.89) vs 1.29 (1.21, 1.37)] and adult weight gain [HR per 5 kg 1.25 (1.23, 1.28) vs 1.10 (1.07, 1.13)] were more strongly associated with the risk of total knee replacement than total hip replacement (P for heterogeneity of HRs <0.0001). Greater body weight and BMI at early and middle adulthood, weight gain and persistent overweight from early to middle adulthood are risk factors for knee and hip OA. Adult weight gain confers stronger risk on knee OA than hip OA. Weight control from early adulthood and avoiding weight gain are important for the prevention of OA.

Analysis of Functional and Radiological Outcome of Total Hip Replacements in Rheumatoid and Osteoarthritis Patients*

Introduction: Outcomes of total hip arthroplasties in rheumatoid are commonly considered as poor and with high rates of complication. Keeping in mind these conflicts of opinions we are going to analyse the functional and radiological outcomes of total hip arthroplasty between osteoarthritis and rheumatoid arthtitis. Patients and Method: Retrospective midterm study of thirty four patients who underwent total hip replacement in Sri Ramachandra medical center for rheumatoid and osteoarthritis (primary and secondary). Of the 44 hips, the indications are rheumatoid arthritis in 20 patients and osteoarthritis in 24 patients. We used the Harris hip score (Modified) for clinical and functional evaluation and plain X-ray pelvis with both hips and proximal femur—AP view and X-ray of the operated hip lateral view for radiological evaluation. Mean follow up is 9 years (8-13 years). Results: The mean pre and latest harris hip score are 44 and 88 respectively. The mean harris hip score in 1st, 3rd and 5th years are 86, 87 and 87 respectively. The mean pre and latest harris hip score in osteoarthritis is 49 and 92, in rheumatoid arthritis is 35 and 74. Conclusion: The results in patients who underwent total hip replacement for osteoarthritis are better than those for rheumatoid arthritis, however the gain in harris hip score is the same. As far as complications are concerned there is no difference between rheumatoid and osteoarthritis. Complications are mostly due to the faulty technique. Both uncemented and cemented total hip replacement give good results in non traumatic indications. In bilateral hip diseases there is considerable pain relief and improvement after the first THR, but the optimal improvement is not seen until the second replacement.