The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case-control study.

Nicolls, Alex S., Kiran, Amit, Pollard, Thomas C. B., Hart, Deborah J., Arden, Charlotte P. A., Spector, Tim, Gill, H. S., Murray, David W., Carr, Andrew J. and Arden, Nigel K. (2011) The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case-control study. Arthritis & Rheumatism, 63 (11), 3392-3400. (doi:10.1002/art.30523). (PMID:21739424)

Abstract

Objective. Subtle deformities of the hip joint are
implicated in the etiology of osteoarthritis (OA) of the
hip. Parameters that quantify these deformities may aid
understanding of these associations. We undertook this
study to examine relationships between such parameters
and the 19-year risk of total hip arthroplasty
(THA) for end-stage OA.
Methods. A new software program designed for
measuring morphologic parameters around the hip was
developed and validated in a reliability study. THA was
the outcome measure for end-stage OA. A nested case–
control study was used with individuals from a cohort of
1,003 women who were recruited at year 1 in 1989 and
followed up to year 20 (the Chingford Study). All hips
with THA by year 20 and 243 randomly selected control
hips were studied. Pelvis radiographs obtained at year 2
were analyzed for variations in hip morphology. Measurements
were compared between the THA case group
and the control group.
Results. Patients with THA had a higher prevalence
of cam deformity than did their respective controls
(median alpha angle 62.4° versus 45.8° [P ? 0.001];
mean modified triangular index height 28.5 mm versus
26.9 mm [P ? 0.001]) as well as a higher prevalence of
acetabular dysplasia (mean lateral center edge angle
29.5° versus 34.3° [P ? 0.001]; median extrusion index
0.25 versus 0.185 [P ? 0.009]). Logistic regression
analyses clustering by subject and adjusting for radiographic
hip OA at year 2 showed that these morphologic
parameters were still significantly associated with THA
by year 20. The alpha angle and lateral center edge
angle predicted the risk of THA independently when
included in the same model.
Conclusion. This investigation describes measurements
that predict the risk of THA for end-stage OA
by year 20, independently of the presence of radiographic
hip OA at year 2. These measurements can be
made on an anteroposterior pelvis radiograph, which is
an inexpensive and commonly used clinical method of
investigation.

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