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Heppenstall SV, Ebsim R, Saunders FR, Lindner C, Gregory JS, Aspden RM, Harvey NC, Cootes T, Tobias JH, Frysz M, Faber BG. Hip geometric parameters are associated with radiographic and clinical hip osteoarthritis: Findings from a cross-sectional study in UK Biobank. Osteoarthritis Cartilage 2023; 31:1627-1635. [PMID: 37704099 PMCID: PMC7615936 DOI: 10.1016/j.joca.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To examine the extent to which geometric parameters derived from dual-energy x-ray absorptiometry (DXA) scans in the UK Biobank study are related to hip osteoarthritis (HOA) independently of sex, age and body size. DESIGN Femoral neck width (FNW), diameter of the femoral head (DFH) and hip axis length (HAL) were derived automatically from left hip DXA scans in UK Biobank using outline points placed around the hip by a machine-learning program. Correlations were calculated between geometric parameters, age, height, and weight. Logistic regression was used to examine the relationship of geometric parameters with radiographic HOA, hospital diagnosed HOA (HESOA), and Cox proportional hazards model to evaluate the relationship with total hip replacement (THR). Analyses were adjusted for sex, age, height, weight, and geometric parameters. RESULTS The study consisted of 40,312 participants. In age and sex-adjusted analyses, FNW, HAL and DFH were related to increased risk of radiographic HOA. In a model adjusted for age, sex, height, weight and other geometric parameters, both FNW and HAL retained independent relationships with radiographic HOA [FNW: odds ratios 2.38 (2.18-2.59), HAL: 1.25 (1.15-1.36)], while DFH was now protective [0.55 (0.50-0.61)]. Only FNW was independently related to HESOA [2.20 (1.80-2.68)] and THR [hazard ratios 2.51 (1.89-3.32)]. CONCLUSION Greater FNW and HAL were independently related to an increased risk of radiographic HOA, whereas greater DFH appeared to be protective. Greater FNW was independently associated with HESOA and THR. These results suggest that DXA-derived geometric parameters, particularly FNW, could help determine HOA and THR risk.
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Affiliation(s)
| | - R Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - F R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - C Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - N C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - T Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - M Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - B G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK.
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2
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Johnson LG, Bortolussi-Courval S, Chehil A, Schaeffer EK, Pawliuk C, Wilson DR, Mulpuri K. Application of statistical shape modeling to the human hip joint: a scoping review. JBI Evid Synth 2023; 21:533-583. [PMID: 36705052 PMCID: PMC9994808 DOI: 10.11124/jbies-22-00175] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective of this scoping review was to identify all examples of the application of statistical shape models to the human hip joint, with a focus on applications, population, methodology, and validation. INTRODUCTION Clinical radiographs are the most common imaging tool for management of hip conditions, but it is unclear whether radiographs can adequately diagnose or predict outcomes of 3D deformity. Statistical shape modeling, a method of describing the variation of a population of shapes using a small number of variables, has been identified as a useful tool to associate 2D images with 3D anatomy. This could allow clinicians and researchers to validate clinical radiographic measures of hip deformity, develop new ones, or predict 3D morphology directly from radiographs. In identifying all previous examples of statistical shape modeling applied to the human hip joint, this review determined the prevalence, strengths, and weaknesses, and identified gaps in the literature. INCLUSION CRITERIA Participants included any human population. The concept included development or application of statistical shape models based on discrete landmarks and principal component analysis. The context included sources that exclusively modeled the hip joint. Only peer-reviewed original research journal articles were eligible for inclusion. METHODS We searched MEDLINE, Embase, Cochrane CENTRAL, IEEE Xplore, Web of Science Core Collection, OCLC PapersFirst, OCLC Proceedings, Networked Digital Library of Theses and Dissertations, ProQuest Dissertations and Theses Global, and Google Scholar for sources published in English between 1992 and 2021. Two reviewers screened sources against the inclusion criteria independently and in duplicate. Data were extracted by 2 reviewers using a REDCap form designed to answer the review study questions, and are presented in narrative, tabular, and graphical form. RESULTS A total of 104 sources were considered eligible based on the inclusion criteria. From these, 122 unique statistical shape models of the human hip were identified based on 86 unique training populations. Models were most often applied as one-off research tools to describe shape in certain populations or to predict outcomes. The demographics of training populations were skewed toward older patients in high-income countries. A mean age between 60 and 79 years was reported in 29 training populations (34%), more than reported in all other age groups combined, and 73 training populations (85%) were reported or inferred to be from Europe and the Americas. Only 4 studies created models in a pediatric population, although 15 articles considered shape variation over time in some way. There were approximately equal numbers of 2D and 3D models. A variety of methods for labeling the training set was observed. Most articles presented some form of validation such as reporting a model's compactness (n = 71), but in-depth validation was rare. CONCLUSIONS Despite the high volume of literature concerning statistical shape models of the human hip, there remains a need for further research in key areas. We identified the lack of models in pediatric populations and low- and middle-income countries as a notable limitation to be addressed in future research.
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Affiliation(s)
- Luke G Johnson
- School of Biomedical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Sara Bortolussi-Courval
- School of Biomedical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada.,Department of Mechanical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada
| | - Anjuli Chehil
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emily K Schaeffer
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Colleen Pawliuk
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - David R Wilson
- Centre for Hip Health and Mobility, Vancouver, BC, Canada.,Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kishore Mulpuri
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
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3
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Dijkstra HP, Ardern CL, Serner A, Mosler AB, Weir A, Roberts NW, Mc Auliffe S, Oke JL, Khan KM, Clarke M, Glyn-Jones S. Primary cam morphology; bump, burden or bog-standard? A concept analysis. Br J Sports Med 2021; 55:1212-1221. [PMID: 34281962 PMCID: PMC8551977 DOI: 10.1136/bjsports-2020-103308] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology. DESIGN We conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology; we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex 'concepts'; the end product is a precise definition that supports the theoretical basis of the chosen concept. RESULTS We propose five defining attributes of primary cam morphology-tissue type, size, site, shape and ownership-in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised. CONCLUSION We introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape-a bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few.
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Affiliation(s)
- H Paul Dijkstra
- Department for Continuing Education, University of Oxford, Oxford, UK .,Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Clare L Ardern
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia.,Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
| | - Andreas Serner
- Research & Scientific Support, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andrea Britt Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Adam Weir
- Aspetar Sports Groin Pain Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Nia Wyn Roberts
- Bodleain Health Care Libraries, University of Oxford Bodleian Libraries, Oxford, UK
| | - Sean Mc Auliffe
- Department of Physical Therapy & Rehabilitation Science, Qatar University, Doha, Qatar
| | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
| | - Siôn Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Staines KA, Hardy R, Samvelyan HJ, Ward KA, Cooper R. Life course longitudinal growth and risk of knee osteoarthritis at age 53 years: evidence from the 1946 British birth cohort study. Osteoarthritis Cartilage 2021; 29:335-340. [PMID: 33383179 PMCID: PMC7955286 DOI: 10.1016/j.joca.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the relationship between height gain across childhood and adolescence with knee osteoarthritis in the MRC National Survey of Health and Development (NSHD). MATERIALS AND METHODS Data are from 3035 male and female participants of the NSHD. Height was measured at ages 2, 4, 6, 7, 11 and 15 years, and self-reported at ages 20 years. Associations between (1) height at each age (2) height gain during specific life periods (3) Super-Imposition by Translation And Rotation (SITAR) growth curve variables of height size, tempo and velocity, and knee osteoarthritis at 53 years were tested. RESULTS In sex-adjusted models, estimated associations between taller height and decreased odds of knee osteoarthritis at age 53 years were small at all ages - the largest associations were an OR of knee osteoarthritis of 0.9 per 5 cm increase in height at age 4, (95% CI 0.7-1.1) and an OR of 0.9 per 5 cm increase in height, (95% CI 0.8-1.0) at age 6. No associations were found between height gain during specific life periods or the SITAR growth curve variables and odds of knee osteoarthritis. CONCLUSIONS There was limited evidence to suggest that taller height in childhood is associated with decreased odds of knee osteoarthritis at age 53 years in this cohort. This work enhances our understanding of osteoarthritis predisposition and the contribution of life course height to this.
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Affiliation(s)
- K A Staines
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh UK.
| | - R Hardy
- Cohort and Longitudinal Studies Enhancement Resources (CLOSER), UCL Institute of Education, London, UK.
| | - H J Samvelyan
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK.
| | - K A Ward
- MRC Lifecourse Epidemiology, Human Development and Health, University of Southampton, Southampton, UK.
| | - R Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK.
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5
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Saunders FR, Gregory JS, Pavlova AV, Muthuri SG, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Cooper R, Ireland A. Motor development in infancy and spine shape in early old age: Findings from a British birth cohort study. J Orthop Res 2020; 38:2740-2748. [PMID: 32162719 PMCID: PMC8641380 DOI: 10.1002/jor.24656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Spine shape changes dramatically in early life, influenced by attainment of developmental milestones such as independent walking. Whether these associations persist across life is unknown. Therefore, we investigated associations between developmental milestones and spine shape, as determined using statistical shape models (SSMs) of lumbar spine from dual-energy X-ray absorptiometry scans in 1327 individuals (688 female) at 60 to 64 years in the MRC National Survey of Health and Development. Lumbar lordosis angle (L4 inferior endplate to T12 superior endplate) was measured using the two-line Cobb method. In analyses adjusted for sex, height, lean and fat mass, socioeconomic position, and birthweight, later walking age was associated with greater lordosis described by SSM1 (regression coefficient, 0.023; 95% CI, 0.000-0.047; P = .05) and direct angle measurement. Modest associations between walking age and less variation in anterior-posterior vertebral size caudally (SSM6) were also observed (0.021; 95% CI, -0.002 to 0.044; P = .07). Sex interactions showed that later walking was associated with larger relative vertebral anterior-posterior dimensions in men (SSM3; -0.043; 95% CI, -0.075 to 0.01; P = .01) but not women (0.018; 95% CI, -0.0007 to 0.043; P = .17). Similar associations were observed between age at independent standing and SSMs but there was little evidence of association between sitting age and spine shape. Unadjusted associations between walking age and SSMs 1 and 6 remained similar after adjustment for potential confounders and mediators. This suggests that these associations may be explained by altered mechanical loading of the spine during childhood growth, although other factors could contribute. Early life motor development, particularly walking, may have a lasting effect on the features of spine morphology with clinical significance.
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Affiliation(s)
- Fiona R. Saunders
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Jennifer S. Gregory
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Anastasia V. Pavlova
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK,School of Health SciencesRobert Gordon UniversityAberdeenUK
| | | | - Rebecca J. Hardy
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK,Cohort and Longitudinal Studies Enhancement Resources (CLOSER)UCL Institute of EducationLondonUK
| | - Kathryn R. Martin
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Rebecca J. Barr
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK,Medicines Monitoring Unit (MEMO), School of Medicine, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - Judith E. Adams
- Manchester Academic Health Science Centre and Radiology, Manchester Royal InfirmaryCentral Manchester University Hospitals NHS Foundation Trust and University of ManchesterManchesterUK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Richard M. Aspden
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Research Centre for Musculoskeletal Science and Sports MedicineManchester Metropolitan UniversityManchesterUK
| | - Alex Ireland
- Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports MedicineManchester Metropolitan UniversityManchesterUK
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6
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Carmona M, Tzioupis C, LiArno S, Faizan A, Argenson JN, Ollivier M. Upper Femur Anatomy Depends on Age and Gender: A Three-Dimensional Computed Tomography Comparative Bone Morphometric Analysis of 628 Healthy Patients' Hips. J Arthroplasty 2019; 34:2487-2493. [PMID: 31266693 DOI: 10.1016/j.arth.2019.05.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The knowledge of proximal femur geometry is essential in the understanding and treatment of hip pathologies. Our aim is to evaluate the range of "normal anatomical values of the proximal femur" and their relationship to age, gender, and ethnicity in a cohort of healthy population, using a 3-dimensional computed tomography automated software. METHODS The pelvis and bilateral femora of 628 healthy individuals (394 males/234 females, mean age 61.5 ± 16.5 years, mean body mass index [BMI] 26.9 ± 5.2 kg/m2) including 2 ethnicities (226 Asians and 406 Caucasians) were assessed with a 3-dimensional computed tomography scan-based system using algorithm-calculated landmarks. The demographic parameters recorded were age, gender, BMI, and ethnicity. The femoral neck-shaft angle (NSA), femoral neck version, femoral offset (FO), and femoral canal flare index (fCFI) were calculated for each individual. Analyses were performed using SPSS version 22. P-values <.05 were considered to indicate statistical significance. RESULTS Overall, the mean NSA was 124.7° (standard deviation [SD] 6.2), mean femoral neck version was 14.5° (SD 8.1), mean FO was 42.9 mm (SD 6.8), and mean fCFI was 3.4 (SD 0.5). Gender was associated with all parameters, with the females presenting more valgus and anteverted hips. Multivariate analysis revealed a lower NSA and fCFI and a higher FO for older individuals. Ethnicity and BMI were not associated with any parameters. CONCLUSION Our results showed that there is a direct relationship of age and gender to the variations in the investigated proximal femur anatomical parameters in a large cohort of healthy individuals. Those important gender-based and age-based differences might advocate for more varus and lateralized component to reproduce preoperative anatomy of male and patients older than 50 years.
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Affiliation(s)
- Max Carmona
- Department of Orthopedics and Traumatology, Pontificia Universidad Católica de Chile, Santiago, Chile; Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France; Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Chris Tzioupis
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France; Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | | | | | - Jean-Noel Argenson
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France; Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France; Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
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7
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Ireland A, Saunders FR, Muthuri SG, Pavlova AV, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Gregory JS, Cooper R. Age at Onset of Walking in Infancy Is Associated With Hip Shape in Early Old Age. J Bone Miner Res 2019; 34:455-463. [PMID: 30496618 PMCID: PMC6446733 DOI: 10.1002/jbmr.3627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/21/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022]
Abstract
Bones' shapes and structures adapt to the muscle and reaction forces they experience during everyday movements. Onset of independent walking, at approximately 12 months, represents the first postnatal exposure of the lower limbs to the large forces associated with bipedal movements; accordingly, earlier walking is associated with greater bone strength. However, associations between early life loading and joint shape have not been explored. We therefore examined associations between walking age and hip shape at age 60 to 64 years in 1423 individuals (740 women) from the MRC National Survey of Health and Development, a nationally representative British birth cohort. Walking age in months was obtained from maternal interview at age 2 years. Ten modes of variation in hip shape (HM1 to HM10), described by statistical shape models, were ascertained from DXA images. In sex-adjusted analyses, earlier walking age was associated with higher HM1 and HM7 scores; these associations were maintained after further adjustment for height, body composition, and socioeconomic position. Earlier walking was also associated with lower HM2 scores in women only, and lower HM4 scores in men only. Taken together, this suggests that earlier walkers have proportionately larger (HM4) and flatter (HM1, HM4) femoral heads, wider (HM1, HM4, HM7) and flatter (HM1, HM7) femoral necks, a smaller neck-shaft angle (HM1, HM4), anteversion (HM2, HM7), and early development of osteophytes (HM1). These results suggest that age at onset of walking in infancy is associated with variations in hip shape in older age. Early walkers have a larger femoral head and neck and smaller neck-shaft angle; these features are associated with reduced hip fracture risk, but also represent an osteoarthritic-like phenotype. Unlike results of previous studies of walking age and bone mass, associations in this study were not affected by adjustment for lean mass, suggesting that associations may relate directly to skeletal loading in early life when joint shape changes rapidly. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Alex Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Fiona R Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Anastasia V Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Kathryn R Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rebecca J Barr
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland
| | - Judith E Adams
- Manchester Academic Health Science Centre and Radiology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Royal Infirmary, Manchester, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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8
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Barr RJ, Gregory JS, Yoshida K, Alesci S, Aspden RM, Reid DM. Significant morphological change in osteoarthritic hips identified over 6-12 months using statistical shape modelling. Osteoarthritis Cartilage 2018; 26:783-789. [PMID: 29673866 DOI: 10.1016/j.joca.2018.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/29/2018] [Accepted: 04/07/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Predicting who will develop osteoarthritis, assessing how rapidly their disease will progress and monitoring early responses to treatment are key to the development of therapeutic agents able to treat this crippling disease and to their future clinical use. Statistical Shape Modelling (SSM) enables quantification of variations in multiple geometric measures describing the whole hip joint to be considered in concert. This prospective study evaluates the responsiveness of SSM to changes in hip-shape within 1 year. METHODS Sixty-two people, mean age 67.1 yrs, were recruited. Dual-energy X-ray Absorptiometry images were taken at three timepoints (baseline, 6 and 12 months). Based on Kellgren-Lawrence grading (KLG) of their baseline images, subjects were classified into control/doubtful OA: KLG < 1 in both hips; moderate OA: KLG = 2; and severe OA: KLG ≥ 3 in their most severe hip. Morphology was quantified using SSM and changes in shape were assessed using generalised estimating equations. Standardized response means (SRMs) were calculated for the first and second 6 month periods, then the full 12 months. RESULTS Disease severity ranged from KLG0-KLG4 in the 124 hips assessed at baseline. Three SSM modes (Modes 1, 3 and 4) were associated with OA severity. Across the whole cohort, SRM magnitudes ranged from 0.16 to 0.63. The greatest subgroup SRM (magnitude 0.91) was observed over 12 months in those subjects with moderate OA (KLG2). CONCLUSIONS We have demonstrated that SSM can capture changes in hip shape over 6 and 12 months across the entire hip joint providing a sensitive measure of hip OA progression.
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Affiliation(s)
- R J Barr
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK; Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, UK.
| | - J S Gregory
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
| | - K Yoshida
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
| | - S Alesci
- Takeda Pharmaceuticals, Washington, DC, USA.
| | - R M Aspden
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
| | - D M Reid
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
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9
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Abstract
Purpose of review This narrative review summarizes the evidence relating hip shape and risk of osteoarthritis at the hip, with a focus on the most recent body of work. Recent findings Hip OA is a prevalent and potentially disabling condition with few effective non-surgical treatment options. Risk factors for hip OA appear to differ somewhat from those at other sites. Variations in hip morphology, whether assessed through standard geometric measures or statistical modeling methods, seem to increase hip OA risk and may provide a novel approach to interventions to reduce or prevent OA. Such variations have also led to focused surgical interventions to "correct" abnormal shape, although comparisons with non-surgical management are lacking. Summary There remains a lack of understanding regarding the optimal management, whether surgical, non-surgical, or a combination, for FAI syndrome. Even less is known regarding other potential morphologic variations that may contribute to OA risk. Additionally, many individuals who have shape variations that would seem to increase their risk will never develop hip OA. Questions remain regarding key risk factors for hip OA development, which individuals should be targeted for therapies, whether directed at symptoms, function, or prevention, and which therapies should be studied and offered. Trials are underway to help address some of these questions.
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