Prognosis of hip pain in general practice: risk factors of later total hip replacement

2007/12/18

In a recent study on risk factors of progressive hip osteoarthritis, Dutch researchers with first author Annet M. Lievense from the Erasmus Medical Center (Rotterdam, Netherlands) found that using the variables obtained from patient history, physical examination, and radiologic findings enables the physician to better identify subjects at high risk for total hip replacement.

The main feature of osteoarthritis of the hip in the elderly is hip pain. In their new study published in the December issue of Arthritis & Rheumatism, Dr. Annet M. Lievense and colleagues assessed the progression of hip osteoarthritis to total hip replacement (THR) and the factors associated with the progression.

A total of 224 persons aged 50 years or older with incident hip pain who attended general practices in the area of Rotterdam, were included in the prospective study. After 3 and 6 years, progression of hip pain, i.e. incidence of THR, was assessed.

After 3 years the disease had progressed in 29 (15%) patients, and 23 (12%) patients received a THR because of severe pain or disability due to hip osteoarthritis. After a 6 year follow-up, the disease had progressed in 45 (28%) patients, and 36 (22%) received a THR. The percentage of patients with greater than normal pain increased from 58% at baseline to 68% after 3 years and 69% after 6 years of follow-up.

Prognostic variables for THR

- related to history: age 60 years or older, morning stiffness, and pain in the groin/medical thigh,
- related to physical examination: decreased extension/adduction, painful internal rotation, and body mass index of equal to or higher than 30,
- related to radiologic findings: a Kellgren/Lawrence grade of 2 or higher

The investigators conclude from their study results that with information obtained from history taking, physical examination, and radiology, clinicians “are now better able to identify persons who are at high risk for progression of hip osteoarthritis. This can be helpful not only to inform patients more precisely about the course of their hip pain, but also for future clinical trials."

Lievense AM, Koes BW, Verhaar JAN, et al. Prognosis of hip pain in general practice: a prospective follow-up study. Arthritis Rheum 207;57(8):1368-74.