1
|
Kulm S, Kaidi AC, Kolin D, Langhans MT, Bostrom MP, Elemento O, Shen TS. Genetic Risk Factors for End-Stage Hip Osteoarthritis Treated With Total Hip Arthroplasty: A Genome-wide Association Study. J Arthroplasty 2023; 38:2149-2153.e1. [PMID: 37179025 DOI: 10.1016/j.arth.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Although a genetic component to hip osteoarthritis (OA) has been described, focused evaluation of the genetic components of end-stage disease is limited. We present a genomewide association study for patients undergoing total hip arthroplasty (THA) to characterize the genetic risk factors associated with end-stage hip osteoarthritis (ESHO), defined as utilization of the procedure. METHODS Patients who underwent primary THA for hip OA were identified in a national patient data repository using administrative codes. Fifteen thousand three hundred and fifty-five patients with ESHO and 374,193 control patients were identified. Whole genome regression of genotypic data for patients who underwent primary THA for hip OA corrected for age, sex, and body mass index (BMI) was performed. Multivariate logistic regression models were used to evaluate the composite genetic risk from the identified genetic variants. RESULTS There were 13 significant genes identified. Composite genetic factors resulted in an odds ratio 1.04 for ESHO (P < .001). The effect of genetics was lower than that of age (Odds Ratio (OR): 2.38; P < .001) and BMI (1.81; P < .001). CONCLUSION Multiple genetic variants, including 5 novel loci, were associated with end-stage hip OA treated with primary THA. Age and BMI were associated with greater odds of developing end-stage disease when compared to genetic factors.
Collapse
Affiliation(s)
- Scott Kulm
- Weill Cornell Medicine, New York, New York; Englander Institute for Precision Medicine, New York, New York
| | - Austin C Kaidi
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - David Kolin
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Mark T Langhans
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Mathias P Bostrom
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Olivier Elemento
- Weill Cornell Medicine, New York, New York; Englander Institute for Precision Medicine, New York, New York
| | - Tony S Shen
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| |
Collapse
|
2
|
Zhu J, Chen W, Hu Y, Qu Y, Yang H, Zeng Y, Hou C, Ge F, Zhou Z, Song H. Physical activity patterns, genetic susceptibility, and risk of hip/knee osteoarthritis: a prospective cohort study based on the UK Biobank. Osteoarthritis Cartilage 2022; 30:1079-1090. [PMID: 35504554 DOI: 10.1016/j.joca.2022.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/04/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The effect of physical activity on hip/knee osteoarthritis (OA) and how it varies by genetic susceptibility to OA remains inconclusive. METHODS In a cohort study of UK Biobank, 436,166 OA-free participants were recruited in 2006-2010 and followed for knee/hip OA until the end of 2020. 28 physical activity-related items were collected at baseline. Cox regression was used to estimate associations between physical activity behaviors, as well as major activity patterns (i.e., significant principal components[PCs] identified by principal component analysis), and risk of OA, adjusting for multiple confounders. We further stratified the analyses by polygenic risk score (PRS) for OA to examine the impact of genetic susceptibility to OA on the studied association. RESULTS During a mean follow-up of 11.15 years, 13,227 hip and 21,119 knee OA cases were identified. 19, out of 28, studied items showed associations with increased OA risk. Compared with low adherence group(<1st tertile of PC score for each pattern), individuals with high adherence to five identified patterns were associated with increased risk of OA. The moderate adherence to "strenuous sports"(HR = 0.93, 95%CI: 0.89-0.97) and "walking for pleasure"(HR = 0.93, 95%CI: 0.89-0.98) patterns was associated with reduced OA. Similar risk patterns were obtained in the stratified analysis by PRS levels for OA. CONCLUSION High intensity of most activity patterns were associated with increased OA. However, a protective effect was suggested for moderate adherence to patterns of "strenuous sports" and "walking for pleasure" that consistent across different genetic susceptibilities, underscoring the potential benefits of moderate-intensity physical activity on OA.
Collapse
Affiliation(s)
- J Zhu
- Department of Orthopedics, Orthopedic Research Institute, and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - W Chen
- Division of Nephrology, Kidney Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Y Hu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Y Qu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - H Yang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Y Zeng
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - C Hou
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - F Ge
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Z Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - H Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
| |
Collapse
|
3
|
Jia B, Jiang Y, Xu Y, Wang Y, Li T. Correlation between growth differentiation factor 5 (rs143383) gene polymorphism and knee osteoarthritis: an updated systematic review and meta-analysis. J Orthop Surg Res 2021; 16:146. [PMID: 33608035 PMCID: PMC7893760 DOI: 10.1186/s13018-021-02269-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/28/2021] [Indexed: 01/11/2023] Open
Abstract
Background A great deal of evidence has supported that growth differentiation factor 5 (GDF5) is associated with the occurrence of knee osteoarthritis (KOA), while their results are not consistent. In the present study, we aimed to explore the association between GDF5 gene polymorphism and KOA for a more credible conclusion. Methods Comprehensive literature searches were carried out in English databases, including PubMed, Embase, Web of Science (WOS), and Cochrane, and Chinese databases, including China National Knowledge Infrastructure (CNKI), WANFANG, and VIP database. After the data were extracted from the required studies, the odds ratios (ORs) and their 95% confidence intervals (CIs) were determined to assess the correlation between GDF5 gene polymorphism and KOA. The publication bias was evaluated by funnel plot. Results According to the inclusion and exclusion criteria, 15 studies on the correlation between GDF5 gene polymorphism and KOA occurrence were eligible for meta-analysis. Among these articles, four studies showed no apparent correlation, while the other 11 studies indicated an obvious correlation. Meanwhile, we also carried out a subgroup analysis of the population. Due to the inevitable heterogeneity, three genetic models were finally selected for analysis. With the allele model (C versus T: OR = 0.79, 95% CI = 0.73~0.87), recessive model (CC versus CT + TT: OR = 0.76, 95% CI = 0.68~0.86), and homozygous model (CC versus TT: OR = 0.66, 95% CI = 0.58~0.76), GDF5 gene polymorphism decreased the risk of KOA. Besides, a significant association was observed in Caucasians, Asians, and Africans. Meanwhile, the protective effect of genotype C (or CC) in the Asian group was little obvious than that in the Caucasian group and the African group. Although the quality of the included studies was above medium-quality, we obtained results with a low level of evidence. Conclusions The results of the meta-analysis showed that the genotype C (or CC) of GDF5 protected against KOA occurrence in Caucasian, Asian, and African populations.
Collapse
Affiliation(s)
- Bin Jia
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.,Medical Department of Qingdao University, Qingdao, 266071, Shandong, China
| | - Yaping Jiang
- Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yingxing Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.,Medical Department of Qingdao University, Qingdao, 266071, Shandong, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| | - Tao Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| |
Collapse
|
4
|
Abdulrahim H, Jiao Q, Swain S, Sehat K, Sarmanova A, Muir K, Zhang W, Doherty M. Constitutional morphological features and risk of hip osteoarthritis: a case-control study using standard radiographs. Ann Rheum Dis 2020; 80:494-501. [PMID: 33229363 DOI: 10.1136/annrheumdis-2020-218739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the risk of association with hip osteoarthritis (OA) of 14 morphological features measured on standard antero-posterior pelvis radiographs. METHODS A case-control study of 566 symptomatic unilateral hip OA cases and 1108 controls without hip OA, using the Genetics of OA and Lifestyle database. Unaffected hips of cases were assumed to reflect pre-OA morphology of the contralateral affected hip. ORs with 95% CI adjusted for confounding factors were calculated using logistic regression. Hierarchical clustering on principal component method was used to identify clusters of morphological features. Proportional risk contribution (PRC) of these morphological features in the context of other risk factors of hip OA was estimated using receiver operating characteristic analysis. RESULTS All morphological features showed right-left symmetry in controls. Each feature was associated with hip OA after adjusting for age, gender and body mass index. Increased sourcil angle had the strongest association (OR: 6.93, 95% CI 5.16 to 9.32). Three clusters were identified. The PRC varied between individual features, as well as between clusters. It was 35% (95% CI 31% to 40%) for all 14 morphological features, compared to 21% (95% CI 19% to 24%) for all other well-established risk factors. CONCLUSIONS Constitutional morphological variation strongly associates with hip OA development and may explain much of its heritability. Relevant morphological measures can be assessed readily on standard radiographs to help predict risk of hip OA. Prospective studies are required to provide further support for causality.
Collapse
Affiliation(s)
| | - Qiang Jiao
- Orthopaedic Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | | | - Khosrow Sehat
- Orthopaedic Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aliya Sarmanova
- Musculoskeletal Research Unit, University of Bristol, Bristol Medical School, Bristol, UK
| | - Kenneth Muir
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Weiya Zhang
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| |
Collapse
|
5
|
Abstract
BACKGROUND A common claim in the orthopaedic literature is that acetabular dysplasia (AD) exists when the center-edge angle of Wiberg (CE angle) is <20 degrees and that AD leads to osteoarthritis (OA). Our purpose is to evaluate the validity of the linkage between AD and OA. METHODS We assess and discuss the theories and the empirical evidence relating AD to OA. Moreover, we test the rule that hips with a CE angle <20 degrees will develop OA by 65 years of age, by looking for exceptions to this rule. RESULTS Wiberg and Cooperman and colleagues present 30 ideal patients for assessing the relationship between AD and OA. Each was arthritis free, with stable AD, CE angle <20 degrees, without signs of subluxation. They were all followed and all developed OA. In the studies by Stulberg and colleagues, and Jacobsen and colleagues, every patient presented with OA, making it difficult to be certain about the appearance of the hip before the onset of OA. In the study by Murphy and colleagues, we have the same problem, as an unknown number of patients already had OA at first assessment. All of these studies used different schemes for diagnosing OA, making the studies difficult to compare. Most of the patients in the studies were of Northern European ancestry, making the results difficult to generalize to other populations. Four patients had CE angles <20 degrees and did not develop severe arthritis by 65 years of age. CONCLUSIONS Our conclusions apply directly to patients of Northern European ancestry. A few patients with stable, mild AD (CE angle 15 to 19 degrees) will be arthritis free at 65 years of age. Almost all patients with stable AD develop OA by 65 years of age. Unstable AD (CE angle <20 degrees, with subluxation) always leads to OA by 65 years of age. It is probably reasonable to extend these conclusions to other populations, but the reader must be prepared to re-evaluate them, as more data accumulates.
Collapse
|
6
|
Slomka B, Rongies W, Sierdzinski J, Dolecki W, Worwag M, Trzepla E. Assessment of postural stability in women with hip osteoarthritis: A case-control study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:56-60. [PMID: 30573173 PMCID: PMC6424653 DOI: 10.1016/j.aott.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 06/19/2018] [Accepted: 07/27/2018] [Indexed: 11/25/2022]
Abstract
Objective The aim of the study was to assessment the impact of hip osteoarthritis on postural stability. Methods One hundred and twenty-five randomly selected women 20–85 years old (mean age of 49 ± 24.4 years) were assigned to three groups based on age, health status and activity level. Group 1 (cases) – elderly women with diagnosed hip osteoarthritis, group 2 (control) - women without hip osteoarthritis, and group 3 (control) - healthy young women. Assessment of postural stability were measured using a WIN-POD Pel 38 electronic podometer. Statistica 10 software was used to perform t-test resulting in significance level of p < 0.05. Results Significant differences in pedobarographic balance measurements were observed between the study groups with eyes opened or closed (deviation length eyes open: group 1–3 and 2–3 p < 0.0001; eyes closed group 1–2 p = 0.19; 1–3 and 2–3 p < 0.0001; deviation area eyes open: group 1-3 and 2–3 p < 0.0001; eyes closed group 1–3 and 2–3 p < 0.0001; deviation velocity eyes open: group1-3 and 2–3 p < 0.0001; eyes closed group 1–2 p < 0.010, 1–3 and 2–3 p < 0.0001). The poorest postural stability was observed in patients with hip osteoarthritis (deviation length eyes open vs eyes closed 180.8/201.7 p = 0.028, deviation area 128.7/145.7 p = 0.771, deviation velocity 5.1/6.1 p < 0.0001), and the best postural stability was observed in young women (deviation length 111.3/137.5 p < 0.0001, deviation area 57/76.9 p = 0.003, deviation velocity 3.4/4.2 p < 0.0001). Conclusion (1) Osteoarthritic degeneration of the hip joint results in a significant disturbance in proprioception. This finding was reflected by the inferior stability parameters collected from subjects with hip osteoarthritis when asked to stand with their eyes closed. These finding were not observed in the other groups. (2) The disorder of the body stability of people with osteoarthritis may be a relative indication for the implantation of hip arthroplasty.
Collapse
|
7
|
Lespasio MJ, Sultan AA, Piuzzi NS, Khlopas A, Husni ME, Muschler GF, Mont MA. Hip Osteoarthritis: A Primer. Perm J 2018; 22:17-084. [PMID: 29309269 DOI: 10.7812/tpp/17-084] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this article is to deliver a concise up-to-date review on hip osteoarthritis. We describe the epidemiology (disease distribution), etiologies (associated risk factors), symptoms, diagnosis and classification, and treatment options for hip osteoarthritis. A quiz serves to assist readers in their understanding of the presented material.
Collapse
Affiliation(s)
- Michelle J Lespasio
- Assistant Professor and Adult Nurse Practitioner in Orthopedic Surgery at the Boston Medical Center in MA.
| | - Assem A Sultan
- Clinical Orthopedic Surgery Fellow at the Cleveland Clinic in OH.
| | - Nicolas S Piuzzi
- Orthopedic Regenerative Medicine and Cellular Therapy Fellow at the Cleveland Clinic in OH.
| | - Anton Khlopas
- Research Fellow in Orthopedic Surgery at the Cleveland Clinic in OH.
| | - M Elaine Husni
- Rheumatologist and Immunologist and Director of the Arthritis & Musculoskeletal Treatment Center in the Department of Rheumatologic and Immunologic Disease at the Cleveland Clinic in OH.
| | - George F Muschler
- Professor of Orthopedic Surgery, Director of the Regenerative Medicine Laboratory, and Attending Physician at the Cleveland Clinic in OH.
| | - Michael A Mont
- Chairman of Orthopedic Surgery at the Cleveland Clinic in OH.
| |
Collapse
|
8
|
Translating Genomic Advances to Physical Therapist Practice: A Closer Look at the Nature and Nurture of Common Diseases. Phys Ther 2016; 96:570-80. [PMID: 26637647 DOI: 10.2522/ptj.20150112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 11/23/2015] [Indexed: 02/09/2023]
Abstract
The Human Genome Project and the International HapMap Project have yielded new understanding of the influence of the human genome on health and disease, advancing health care in significant ways. In personalized medicine, genetic factors are used to identify disease risk and tailor preventive and therapeutic regimens. Insight into the genetic bases of cellular processes is revealing the causes of disease and effects of exercise. Many diseases known to have a major lifestyle contribution are highly influenced by common genetic variants. Genetic variants are associated with increased risk for common diseases such as cardiovascular disease and osteoarthritis. Exercise response also is influenced by genetic factors. Knowledge of genetic factors can help clinicians better understand interindividual differences in disease presentation, pain experience, and exercise response. Family health history is an important genetic tool and encourages clinicians to consider the wider client-family unit. Clinicians in this new era need to be prepared to guide patients and their families on a variety of genomics-related concerns, including genetic testing and other ethical, legal, or social issues. Thus, it is essential that clinicians reconsider the role of genetics in the preservation of wellness and risk for disease to identify ways to best optimize fitness, health, or recovery. Clinicians with knowledge of the influence of genetic variants on health and disease will be uniquely positioned to institute individualized lifestyle interventions, thereby fulfilling roles in prevention and wellness. This article describes how discoveries in genomics are rapidly evolving the understanding of health and disease by highlighting 2 conditions: cardiovascular disease and osteoarthritis. Genetic factors related to exercise effects also are considered.
Collapse
|
9
|
Raphael IJ, Rasouli MR, Kepler CK, Restrepo S, Albert TJ, Radcliff KE. Pelvic Incidence in Patients with Hip Osteoarthritis. THE ARCHIVES OF BONE AND JOINT SURGERY 2016; 4:132-136. [PMID: 27200390 PMCID: PMC4852038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/07/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Hip osteoarthritis (OA) is a major cause of pain and disability that results in considerable social and medical costs. Mechanics such as posture, alignment and orientation of the hips and the spinal column and the relationship between these factors have been implicated in the development of both hip and spine pathologies. This study aims to test the hypothesis if pelvic incidence varies in patients with and without osteoarthritis. We assessed the relationship between spinopelvic alignment as measured by pelvic incidence (PI) and the presence of hip OA. METHODS We collected supine pelvis CT scans of 1,012 consecutive patients not known to have hip OA. Our first group consisted of 95 patients with moderate to severe hip OA as per radiology reports. The second group included 87 patients with no evidence of hip OA. Power analysis revealed the need for 77 patients per group to find a mean difference in PI of 5° or less between both groups. Two trained physicians independently measured the PI to account for inter-observer reliability. RESULTS Patients with moderate to severe hip OA had a mean PI of 56.5°±12.8°. The mean PI for patients without hip OA was 57.2°±7.5°. An independent samples t-test revealed no significant difference between the PI values of the two groups. Spearman's correlation coefficient of 0.754 demonstrated a high inter-observer reliability. CONCLUSION There was no difference in PI angle of hip OA patients and "healthy" patients. Our measurements of patients without OA were almost identical to the reported normal PI values in the literature. It appears that hip OA is not associated with PI angle, refuting the hypothesis made in previous studies, stating that elevated PI contributes to the future development of hip arthritis. CT scan seems to be a reliable and accurate way of assessing pelvic incidence.
Collapse
Affiliation(s)
- Ibrahim J Raphael
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mohammad R Rasouli
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K Kepler
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Santiago Restrepo
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Todd J Albert
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kris E Radcliff
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
10
|
Skousgaard SG, Hjelmborg J, Skytthe A, Brandt LPA, Möller S, Overgaard S. Probability and heritability estimates on primary osteoarthritis of the hip leading to total hip arthroplasty: a nationwide population based follow-up study in Danish twins. Arthritis Res Ther 2015; 17:336. [PMID: 26589897 PMCID: PMC4654897 DOI: 10.1186/s13075-015-0854-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/05/2015] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Primary hip osteoarthritis, radiographic as well as symptomatic, is highly associated with increasing age in both genders. However, little is known about the mechanisms behind this, in particular if this increase is caused by genetic factors. This study examined the risk and heritability of primary osteoarthritis of the hip leading to a total hip arthroplasty, and if this heritability increased with increasing age. METHODS In a nationwide population-based follow-up study 118,788 twins from the Danish Twin Register and 90,007 individuals from the Danish Hip Arthroplasty Register for the period 1995 to 2010 were examined. Our main outcomes were the cumulative incidence, proband-wise concordance and heritability on age, within-pair correlations in monozygotic and dizygotic twin pairs, and the genetic and environmental influence estimated in models taking into account that individuals may not have had a total hip arthroplasty at the time of follow-up. RESULTS There were 94,063 twins eligible for analyses, comprising 835 cases of 36 concordant and 763 discordant twin pairs. The probability increased particularly from 50 years of age. After sex and age adjustment a significant additive genetic component of 47% (12:79), a shared environmental component of 21% (2:76) and a unique environment component of 32% (21:41) accounted for the variation in population liability to total hip arthroplasty. The sex-adjusted proband-wise concordance and heritability on age indicated an increasing age-associated genetic influence onwards from 60 years of age. CONCLUSION The cumulative incidence in primary hip osteoarthritis leading to total hip arthroplasty increases in particular after the age of 50 years in both genders. Family factors of genes and shared environment are highly significant and account for 68% of the variation in the population liability to total hip arthroplasty; however, the genetic influence increases significantly from 60 years of age onwards.
Collapse
Affiliation(s)
- Søren Glud Skousgaard
- Department of Occupational and Environmental Medicine, Odense University Hospital, 5000, Odense C, Denmark. .,Department of Orthopaedic Surgery and Traumatology & Orthopaedic Research Unit, Odense University Hospital, 5000, Odense C, Denmark. .,Institute of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.
| | - Jacob Hjelmborg
- Department of Epidemiology, Biostatistics, and Biodemography, The Danish Twin Registry, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark.
| | - Axel Skytthe
- Department of Epidemiology, Biostatistics, and Biodemography, The Danish Twin Registry, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark.
| | - Lars Peter Andreas Brandt
- Department of Occupational and Environmental Medicine, Odense University Hospital, 5000, Odense C, Denmark. .,Institute of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.
| | - Sören Möller
- Department of Epidemiology, Biostatistics, and Biodemography, The Danish Twin Registry, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark.
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology & Orthopaedic Research Unit, Odense University Hospital, 5000, Odense C, Denmark. .,Institute of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.
| |
Collapse
|
11
|
Packer JD, Safran MR. The etiology of primary femoroacetabular impingement: genetics or acquired deformity? J Hip Preserv Surg 2015; 2:249-57. [PMID: 27011846 PMCID: PMC4765309 DOI: 10.1093/jhps/hnv046] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 04/15/2015] [Accepted: 05/19/2015] [Indexed: 02/03/2023] Open
Abstract
The etiology of primary femoroacetabular impingement (FAI) remains controversial. Both genetic and acquired causes have been postulated and studied. While recent studies suggest that genetic factors may have a role in the development of FAI, there is no conclusive evidence that FAI is transmitted genetically. Currently, the most popular theory for the development of cam-type deformities is that a repetitive injury to the proximal femoral physis occurs during a critical period of development. There is a correlation between a high volume of impact activities during adolescence and the development of cam-type deformities. Multiple studies have found a high prevalence of FAI in elite football, ice hockey, basketball and soccer players. In this article, we review the current literature relating to the etiology of primary FAI.
Collapse
Affiliation(s)
- Jonathan D Packer
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA 94063, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA 94063, USA
| |
Collapse
|
12
|
Van Houcke J, Yau WP, Yan CH, Huysse W, Dechamps H, Lau WH, Wong CS, Pattyn C, Audenaert EA. Prevalence of radiographic parameters predisposing to femoroacetabular impingement in young asymptomatic Chinese and white subjects. J Bone Joint Surg Am 2015; 97:310-7. [PMID: 25695983 PMCID: PMC4325085 DOI: 10.2106/jbjs.m.01538] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteoarthritis of the hip is five to ten times more common in white people than in Chinese people. Little is known about the true prevalence of femoroacetabular impingement or its role in the development of osteoarthritis in the Chinese population. A cross-sectional study of both white and Chinese asymptomatic individuals was conducted to compare the prevalences of radiographic features posing a risk for femoroacetabular impingement in the two groups. It was hypothesized that that there would be proportional differences in hip anatomy between the white and Asian populations. METHODS Pelvic computed tomography scans of 201 subjects (ninety-nine white Belgians and 102 Chinese; 105 men and ninety-six women) without hip pain who were eighteen to forty years of age were assessed. The original axial images were reformatted to three-dimensional pelvic models simulating standardized radiographic views. Ten radiographic parameters predisposing to femoroacetabular impingement were measured: alpha angle, anterior offset ratio, and caput-collum-diaphyseal angle on the femoral side and crossover sign, ischial spine projection, acetabular anteversion angle, center-edge angle, acetabular angle of Sharp, Tönnis angle, and anterior acetabular head index on the acetabular side. RESULTS The white subjects had a less spherical femoral head than the Chinese subjects (average alpha angle, 56° compared with 50°; p<0.001). The Chinese subjects had less lateral acetabular coverage than the white subjects, with average center-edge angles of 35° and 39° (p<0.001) and acetabular angles of Sharp of 38° and 36° (p<0.001), respectively. A shallower acetabular configuration was predominantly present in Chinese women. CONCLUSIONS Significant differences in hip anatomy were demonstrated between young asymptomatic Chinese and white subjects. However, the absolute size of the observed differences appears to contrast with the reported low prevalence of femoroacetabular impingement in Chinese individuals compared with the high prevalence in white populations.
Collapse
Affiliation(s)
- Jan Van Houcke
- Departments of Orthopaedic Surgery and Traumatology (J.V.H., H.D., C.P., and E.A.A.) and Radiology (W.H.), Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. E-mail address for E.A. Audenaert:
| | - Wan Pan Yau
- Departments of Orthopaedic Surgery and Traumatology (W.P.Y. and C.H.Y.) and Radiology (W.H.L. and C.S.W.), Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
| | - Chun Hoi Yan
- Departments of Orthopaedic Surgery and Traumatology (W.P.Y. and C.H.Y.) and Radiology (W.H.L. and C.S.W.), Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
| | - Wouter Huysse
- Departments of Orthopaedic Surgery and Traumatology (J.V.H., H.D., C.P., and E.A.A.) and Radiology (W.H.), Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. E-mail address for E.A. Audenaert:
| | - Hannes Dechamps
- Departments of Orthopaedic Surgery and Traumatology (J.V.H., H.D., C.P., and E.A.A.) and Radiology (W.H.), Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. E-mail address for E.A. Audenaert:
| | - Wing Hang Lau
- Departments of Orthopaedic Surgery and Traumatology (W.P.Y. and C.H.Y.) and Radiology (W.H.L. and C.S.W.), Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
| | - Chun Sing Wong
- Departments of Orthopaedic Surgery and Traumatology (W.P.Y. and C.H.Y.) and Radiology (W.H.L. and C.S.W.), Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
| | - Christophe Pattyn
- Departments of Orthopaedic Surgery and Traumatology (J.V.H., H.D., C.P., and E.A.A.) and Radiology (W.H.), Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. E-mail address for E.A. Audenaert:
| | - Emmanuel Albert Audenaert
- Departments of Orthopaedic Surgery and Traumatology (J.V.H., H.D., C.P., and E.A.A.) and Radiology (W.H.), Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. E-mail address for E.A. Audenaert:
| |
Collapse
|
13
|
Genetics of osteoarthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
14
|
Khanna V, Beaulé PE. Defining structural abnormalities of the hip joint at risk of degeneration. J Hip Preserv Surg 2014; 1:12-20. [PMID: 27011797 PMCID: PMC4765260 DOI: 10.1093/jhps/hnu004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/13/2014] [Indexed: 11/13/2022] Open
Abstract
The purpose of this review is to explore the mounting evidence that primary osteoarthritis is secondary to childhood disorders such as dysplasia and/or to subtle morphologic and structural to subtle morphologic and structural abnormalities of the proximal femur and/or acetabulum that were previously unrecognized or underestimated. These structural deformities lead to early impingement through range of motion and subsequent joint degeneration. The review also presents a brief synopsis of the genetic components that influence structural morphology of the hip joint and the impact of genetic pathways on OA development. If subtle deformities can be shown to be effective predictors of OA in the general population, it may be possible to identify hips that are at risk before they progress to end-stage OA. Furthermore, if these early risk factors are modifiable, it may be possible to implement preventative measures before the requirement of total hip arthroplasty.
Collapse
Affiliation(s)
- Vickas Khanna
- Division of Orthopedic Surgery, University of Ottawa, 501 Smyth Road, PO Box 502, Ottawa, ON, Canada K1H 8L6
| | - Paul E Beaulé
- Division of Orthopedic Surgery, University of Ottawa, 501 Smyth Road, PO Box 502, Ottawa, ON, Canada K1H 8L6
| |
Collapse
|
15
|
|
16
|
|
17
|
Yilmaz S, Erdem H, Tunay S, Torun D, Genc H, Tunca Y, Karadag O, Simsek I, Bahce M, Pay S, Dinc A. The presence of MEFV gene mutations in patients with primary osteoarthritis who require surgery. Korean J Intern Med 2013; 28:594-8. [PMID: 24009456 PMCID: PMC3759766 DOI: 10.3904/kjim.2013.28.5.594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 11/29/2012] [Accepted: 03/15/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Chronic arthritis of familial Mediterranean fever (FMF) involves weight-bearing joints and can occur in patients without a history of acute attack. Our aim was to investigate a possible causal relationship between FMF and osteoarthritis in a population in which FMF is quite common. METHODS Patients with late stage primary osteoarthritis were enrolled, and five MEFV gene mutations were investigated. The frequency of MEFV gene mutations was compared among patients with osteoarthritis and a previous healthy group from our center. RESULTS One hundred patients with primary osteoarthritis and 100 healthy controls were studied. The frequency of MEFV gene mutations was significantly lower in the osteoarthritis group (9% vs. 19%). M694V was the most frequent mutation (5%) in the osteoarthritis group, whereas in the control group, E148Q was the most common (16%). In subgroup analyses, the mutation frequency of patients with hip osteoarthritis was not different from that of patients with knee osteoarthritis and controls (7.1%, 9.7%, and 19%, respectively). There were no differences among the three groups with respect to MEFV gene mutations other than E148Q (8.1% vs. 3.6%). E148Q was significantly lower in the osteoarthritis group than in the controls (16% vs. 1%), although the mutations did not differ between patients with knee osteoarthritis and controls. CONCLUSIONS In a population with a high prevalence of MEFV gene mutations, we did not find an increased mutation rate in patients with primary osteoarthritis. Furthermore, we found that some mutations were significantly less frequent in patients with osteoarthritis. Although the number of patients studied was insufficient to claim that E148Q gene mutation protects against osteoarthritis, the potential of this gene merits further investigation.
Collapse
Affiliation(s)
- Sedat Yilmaz
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| | - Hakan Erdem
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| | - Servet Tunay
- Department of Orthopedic Surgery, Gulhane School of Medicine, Ankara, Turkey
| | - Deniz Torun
- Department of Medical Genetics, Gulhane School of Medicine, Ankara, Turkey
| | - Halil Genc
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Yusuf Tunca
- Department of Medical Genetics, Gulhane School of Medicine, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| | - Ismail Simsek
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| | - Muhterem Bahce
- Department of Medical Genetics, Gulhane School of Medicine, Ankara, Turkey
| | - Salih Pay
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| | - Ayhan Dinc
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| |
Collapse
|
18
|
Abstract
Osteoarthritis (OA), the most common form of arthritis, is a highly debilitating disease of the joints and can lead to severe pain and disability. There is no cure for OA. Current treatments often fail to alleviate its symptoms leading to an increased demand for joint replacement surgery. Previous epidemiological and genetic research has established that OA is a multifactorial disease with both environmental and genetic components. Over the past 6 years, a candidate gene study and several genome-wide association scans (GWAS) in populations of Asian and European descent have collectively established 15 loci associated with knee or hip OA that have been replicated with genome-wide significance, shedding some light on the aetiogenesis of the disease. All OA associated variants to date are common in frequency and appear to confer moderate to small effect sizes. Some of the associated variants are found within or near genes with clear roles in OA pathogenesis, whereas others point to unsuspected, less characterised pathways. These studies have also provided further evidence in support of the existence of ethnic, sex, and joint specific effects in OA and have highlighted the importance of expanded and more homogeneous phenotype definitions in genetic studies of OA.
Collapse
|
19
|
Hoaglund FT. Primary osteoarthritis of the hip: a genetic disease caused by European genetic variants. J Bone Joint Surg Am 2013; 95:463-8. [PMID: 23467870 DOI: 10.2106/jbjs.l.00077] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Primary osteoarthritis of the hip is a separate phenotype that occurs at a rate of 3% to 6% in the populations of the world with European ancestry. In all non-European populations, there is a consistent rarity of primary osteoarthritis that suggests a different etiology for these few patients. Family, sibling, and twin studies prove primary osteoarthritis to be a genetic disease with a 50% heritability caused by European genetic variants. The genetic basis is reinforced by the lower rate of primary osteoarthritis in American minorities consistent with their degree of European gene admixture. Whether the mechanism of degeneration of primary osteoarthritis may be secondary through a morphologic deformity, such as femoroacetabular impingement, remains unknown. The virtual absence of the disease in non-Europeans indicates that the European gene component is necessary for the expression of this separate phenotype of osteoarthritis.
Collapse
|
20
|
Mitchell R, Huitema L, Skinner R, Brunt L, Severn C, Schulte-Merker S, Hammond C. New tools for studying osteoarthritis genetics in zebrafish. Osteoarthritis Cartilage 2013; 21:269-78. [PMID: 23159952 PMCID: PMC3560059 DOI: 10.1016/j.joca.2012.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 10/17/2012] [Accepted: 11/05/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Increasing evidence points to a strong genetic component to osteoarthritis (OA) and that certain changes that occur in osteoarthritic cartilage recapitulate the developmental process of endochondral ossification. As zebrafish are a well validated model for genetic studies and developmental biology, our objective was to establish the spatiotemporal expression pattern of a number of OA susceptibility genes in the larval zebrafish providing a platform for functional studies into the role of these genes in OA. DESIGN We identified the zebrafish homologues for Mcf2l, Gdf5, PthrP/Pthlh, Col9a2, and Col10a1 from the Ensembl genome browser. Labelled probes were generated for these genes and in situ hybridisations were performed on wild type zebrafish larvae. In addition, we generated transgenic reporter lines by modification of bacterial artificial chromosomes (BACs) containing full length promoters for col2a1 and col10a1. RESULTS For the first time, we show the spatiotemporal expression pattern of Mcf2l. Furthermore, we show that all six putative OA genes are dynamically expressed during zebrafish larval development, and that all are expressed in the developing skeletal system. Furthermore, we demonstrate that the transgenic reporters we have generated for col2a1 and col10a1 can be used to visualise chondrocyte hypertrophy in vivo. CONCLUSION In this study we describe the expression pattern of six OA susceptibility genes in zebrafish larvae and the generation of two new transgenic lines marking chondrocytes at different stages of maturation. Moreover, the tools used demonstrate the utility of the zebrafish model for functional studies on genes identified as playing a role in OA.
Collapse
Affiliation(s)
- R.E. Mitchell
- Department of Biochemistry, University of Bristol, Bristol BS8 1TD, UK
| | - L.F.A. Huitema
- Hubrecht Institute, KNAW & UMC, Utrecht 3584 CT, The Netherlands
| | - R.E.H. Skinner
- Department of Biochemistry, University of Bristol, Bristol BS8 1TD, UK
| | - L.H. Brunt
- Department of Biochemistry, University of Bristol, Bristol BS8 1TD, UK
| | - C. Severn
- Department of Biochemistry, University of Bristol, Bristol BS8 1TD, UK
| | - S. Schulte-Merker
- Hubrecht Institute, KNAW & UMC, Utrecht 3584 CT, The Netherlands,EZO, Wageningen University, The Netherlands
| | - C.L. Hammond
- Department of Biochemistry, University of Bristol, Bristol BS8 1TD, UK,Department of Physiology & Pharmacology, University of Bristol, Bristol BS8 1TD, UK,Address correspondence and reprint requests to: C.L. Hammond, Department of Biochemistry, University of Bristol, Bristol BS8 1TD, UK.
| |
Collapse
|
21
|
Pollard TCB, Batra RN, Judge A, Watkins B, McNally EG, Gill HS, Thomas GER, Glyn-Jones S, Arden NK, Carr AJ. The hereditary predisposition to hip osteoarthritis and its association with abnormal joint morphology. Osteoarthritis Cartilage 2013; 21:314-21. [PMID: 23123686 DOI: 10.1016/j.joca.2012.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 10/07/2012] [Accepted: 10/26/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Genetic factors and abnormalities of joint morphology are important in the aetiology of hip osteoarthritis (OA). The extent to which genetic influences are manifest through joint morphology has undergone limited investigation. Using a cohort with an hereditary predisposition to end-stage hip OA and a control group with no inherited risk, we aimed to identify associations with abnormal joint morphology and clinical features. DESIGN One hundred and twenty-three individuals (mean age 52 years) with a family history of total hip arthroplasty (THA) (termed 'sibkids') were compared with 80 spouse controls. Morphology was assessed using standardised radiographs and cam, dysplasia, and pincer deformities defined. Regression modelling described the association of cohort with abnormal joint morphology, adjusting for confounders [age, gender, body mass index (BMI), OA, and osteophyte]. RESULTS Sibkids had an odds ratio of 2.1 [95%confidence interval (CI) 1.3-3.5] for cam deformity. There were no differences in the prevalence of dysplasia or pincer deformities. In both groups, hips with cam deformities or dysplasia were more likely to have clinical features than normal hips [odds ratio (OR) 4.46 (1.8-11.3), and 4.40 (1.4-14.3) respectively]. Pincer deformity was associated with positive signs in the sibkids but not in the controls (OR 3.0; 1.1-8.2). DISCUSSION After adjustment for confounders that cause secondary morphological change, individuals with an hereditary predisposition to end-stage hip OA had a higher prevalence of morphological abnormalities associated with hip OA. Sibkids were more likely to demonstrate clinical features in the presence of pincer deformity, suggesting that the genes are acting not only through abnormal morphology but also through other factors that influence the prevalence of pain.
Collapse
Affiliation(s)
- T C B Pollard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre NHS Trust, Headington, Oxford, United Kingdom.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Dudda M, Kim YJ, Zhang Y, Nevitt MC, Xu L, Niu J, Goggins J, Doherty M, Felson DT. Morphologic differences between the hips of Chinese women and white women: could they account for the ethnic difference in the prevalence of hip osteoarthritis? ACTA ACUST UNITED AC 2013; 63:2992-9. [PMID: 21647861 DOI: 10.1002/art.30472] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Hip osteoarthritis (OA) is a common disabling disease, which has a much higher prevalence in whites than in Asians. The reasons for this ethnic difference in prevalence are unknown. Hip OA is often thought to be secondary to morphologic abnormalities. This study was undertaken to examine whether particular abnormalities predisposing to hip OA occur more frequently in whites and whether these differences in hip shape account for differences in the prevalence of OA. METHODS A morphometric study was performed on 400 hips of 200 female participants without OA from 2 studies, the Beijing OA Study and the Study of Osteoporotic Fractures from the US. We focused on measures of hip dysplasia and impingement (lateral center-edge angle, impingement angle, acetabular slope, femoral head-to-femoral neck ratio, and the crossover sign) and compared data from the hips of Chinese and white women. RESULTS Compared with their Chinese counterparts, white women had a lower mean impingement angle (83.6° versus 87.0°; P=0.03) and were more likely to have center-edge angles suggestive of impingement (>35°; 11% of hips in Chinese versus 23% of hips in whites, P=0.008). In contrast, low center-edge angles suggesting dysplasia (<20°) were found more often in Chinese women (22% of hips in Chinese versus 7% of hips in whites, P=0.005). CONCLUSION In a study of elderly women without signs of OA, the morphometry of impingement and asphericity was more common in the hips of white women compared with Chinese women. Our findings suggest that whites may be at higher risk of hip OA than Chinese because of morphologic findings that predispose whites to femoroacetabular impingement.
Collapse
Affiliation(s)
- Marcel Dudda
- Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02118, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Liu J, Cai W, Zhang H, He C, Deng L. Rs143383 in the growth differentiation factor 5 (GDF5) gene significantly associated with osteoarthritis (OA)-a comprehensive meta-analysis. Int J Med Sci 2013; 10:312-9. [PMID: 23423687 PMCID: PMC3575627 DOI: 10.7150/ijms.5455] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 01/09/2013] [Indexed: 11/17/2022] Open
Abstract
Family, twin, adoption studies show osteoarthritis (OA) has a substantial genetic component. Several studies have shown an association between OA and Growth Differentiation Factor 5 (GDF5), some others have not. Thus, the status of the OA-GDF5 association is uncertain. This meta-analysis was applied to case-control studies of the association between OA and GDF5 to assess the joint evidence for the association, the influence of individual studies, and evidence for publication bias. Relevant studies were identified from the following electronic databases: MEDLINE and current contents before Feb. 2012. For the case-control studies, the authors found 1) support for the association between OA and GDF5. The rs143383 polymorphism was significantly associated with OA [fixed: OR and 95% CI: 1.193 (1.139-1.249), p < 0.001; random: OR and 95% CI: 1.204 (1.135-1.276), p < 0.001], 2) no evidence that this association was accounted for by any one study, and 3) no evidence for publication bias. Although the effect size of the association between OA and GDF5 is small, there is suggestive evidence for an association. Further studies are needed to clarify what variant of GDF5 (or some nearby gene) accounts for this association.
Collapse
Affiliation(s)
- Jie Liu
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Orthopaedics and Traumatology, Department of Orthopaedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | | | | | | | | |
Collapse
|
24
|
Zeggini E, Panoutsopoulou K, Southam L, Rayner NW, Day-Williams AG, Lopes MC, Boraska V, Esko T, Evangelou E, Hoffman A, Houwing-Duistermaat JJ, Ingvarsson T, Jonsdottir I, Jonnson H, Kerkhof HJ, Kloppenburg M, Bos SD, Mangino M, Metrustry S, Slagboom PE, Thorleifsson G, Raine EVA, Ratnayake M, Ricketts M, Beazley C, Blackburn H, Bumpstead S, Elliott KS, Hunt SE, Potter SC, Shin SY, Yadav VK, Zhai G, Sherburn K, Dixon K, Arden E, Aslam N, Battley PK, Carluke I, Doherty S, Gordon A, Joseph J, Keen R, Koller NC, Mitchell S, O'Neill F, Paling E, Reed MR, Rivadeneira F, Swift D, Walker K, Watkins B, Wheeler M, Birrell F, Ioannidis JPA, Meulenbelt I, Metspalu A, Rai A, Salter D, Stefansson K, Stykarsdottir U, Uitterlinden AG, van Meurs JBJ, Chapman K, Deloukas P, Ollier WER, Wallis GA, Arden N, Carr A, Doherty M, McCaskie A, Willkinson JM, Ralston SH, Valdes AM, Spector TD, Loughlin J. Identification of new susceptibility loci for osteoarthritis (arcOGEN): a genome-wide association study. Lancet 2012; 380:815-23. [PMID: 22763110 PMCID: PMC3443899 DOI: 10.1016/s0140-6736(12)60681-3] [Citation(s) in RCA: 278] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Osteoarthritis is the most common form of arthritis worldwide and is a major cause of pain and disability in elderly people. The health economic burden of osteoarthritis is increasing commensurate with obesity prevalence and longevity. Osteoarthritis has a strong genetic component but the success of previous genetic studies has been restricted due to insufficient sample sizes and phenotype heterogeneity. METHODS We undertook a large genome-wide association study (GWAS) in 7410 unrelated and retrospectively and prospectively selected patients with severe osteoarthritis in the arcOGEN study, 80% of whom had undergone total joint replacement, and 11,009 unrelated controls from the UK. We replicated the most promising signals in an independent set of up to 7473 cases and 42,938 controls, from studies in Iceland, Estonia, the Netherlands, and the UK. All patients and controls were of European descent. FINDINGS We identified five genome-wide significant loci (binomial test p≤5·0×10(-8)) for association with osteoarthritis and three loci just below this threshold. The strongest association was on chromosome 3 with rs6976 (odds ratio 1·12 [95% CI 1·08-1·16]; p=7·24×10(-11)), which is in perfect linkage disequilibrium with rs11177. This SNP encodes a missense polymorphism within the nucleostemin-encoding gene GNL3. Levels of nucleostemin were raised in chondrocytes from patients with osteoarthritis in functional studies. Other significant loci were on chromosome 9 close to ASTN2, chromosome 6 between FILIP1 and SENP6, chromosome 12 close to KLHDC5 and PTHLH, and in another region of chromosome 12 close to CHST11. One of the signals close to genome-wide significance was within the FTO gene, which is involved in regulation of bodyweight-a strong risk factor for osteoarthritis. All risk variants were common in frequency and exerted small effects. INTERPRETATION Our findings provide insight into the genetics of arthritis and identify new pathways that might be amenable to future therapeutic intervention. FUNDING arcOGEN was funded by a special purpose grant from Arthritis Research UK.
Collapse
|
25
|
Pollard TCB, Batra RN, Judge A, Watkins B, McNally EG, Gill HS, Arden NK, Carr AJ. Genetic predisposition to the presence and 5-year clinical progression of hip osteoarthritis. Osteoarthritis Cartilage 2012; 20:368-375. [PMID: 22343497 DOI: 10.1016/j.joca.2012.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 01/31/2012] [Accepted: 02/07/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Genetic factors are important in the aetiology of hip osteoarthritis (OA), but studies are limited by cross-sectional design and poor association with clinically important disease. Identifying cohorts with progressive OA will facilitate development of OA biomarkers. Using a middle-aged cohort with genetic predisposition to hip OA and a control group, we compared the prevalence of clinical and radiographic hip OA and incidence of progression over 5 years. DESIGN 123 individuals (mean age 52 years) with a family history of total hip arthroplasty (THA) ('sibkids') were compared with 80 (mean age 54 years) controls. The prevalence of radiographic OA [scored according to Kellgren & Lawrence (K&L)], clinical features, and incidence of clinical progression over a 5-year period were compared. A multivariate logistic regression model was used to adjust for confounders. RESULTS Sibkids had odds ratios (ORs) of 2.7 [95% confidence interval (CI) 1.1-6.3, P = 0.02] for hip OA (K&L grade ≥2), 3.4 (1.4-8.4, P = 0.008) for clinical signs, and 2.1 (0.8-5.8, P = 0.14) for signs and symptoms. Over 5 years, sibkids had ORs of 4.7 (1.7-13.2, P = 0.003) for the development of signs, and 3.2 (1.0-10.3, P = 0.047) for the development of signs and symptoms. DISCUSSION Compared to a control group and after adjustment for confounders, individuals with genetic predisposition to end-stage hip OA have higher prevalence of OA, clinical features, and progression. In addition to structural degeneration, the inherited risk may include predisposition to pain. Genetically-loaded cohorts are useful to develop hip OA biomarkers, as they develop progressive disease at a young age.
Collapse
Affiliation(s)
- T C B Pollard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the NIHR Biomedical Research Unit, University of Oxford, United Kingdom.
| | - R N Batra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the NIHR Biomedical Research Unit, University of Oxford, United Kingdom
| | - A Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the NIHR Biomedical Research Unit, University of Oxford, United Kingdom
| | - B Watkins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the NIHR Biomedical Research Unit, University of Oxford, United Kingdom
| | - E G McNally
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the NIHR Biomedical Research Unit, University of Oxford, United Kingdom
| | - H S Gill
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the NIHR Biomedical Research Unit, University of Oxford, United Kingdom
| | - N K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the NIHR Biomedical Research Unit, University of Oxford, United Kingdom
| | - A J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the NIHR Biomedical Research Unit, University of Oxford, United Kingdom
| |
Collapse
|
26
|
Harris-Hayes M, Royer NK. Relationship of acetabular dysplasia and femoroacetabular impingement to hip osteoarthritis: a focused review. PM R 2012; 3:1055-1067.e1. [PMID: 22108232 DOI: 10.1016/j.pmrj.2011.08.533] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/05/2011] [Accepted: 08/13/2011] [Indexed: 11/28/2022]
Abstract
Hip osteoarthritis (OA) leads to significant functional limitations and economic burden. If modifiable risk factors for hip OA are identified, it may be possible to implement preventative measures. Bony abnormalities associated with acetabular dysplasia (AD) and femoroacetabular impingement have been recently implicated as risk factors for hip OA. The purpose of this focused review is to summarize the available evidence describing the relationship between bony abnormalities and hip OA. A librarian-assisted database search with PubMed, Embase, and CENTRAL was performed. Relevant articles were identified and assessed for inclusion criteria. The authors reviewed cohort and case-control studies that reported on the association between abnormal hip morphology and hip OA. The available literature suggests that an association exists between bony abnormalities found in AD and femoroacetabular impingement and hip OA, and preliminary evidence suggests that AD is a risk factor for OA; however, these conclusions are based on limited evidence. Prospective, longitudinal studies are needed to confirm the causal relationship between abnormal hip morphology and the future development of hip OA.
Collapse
Affiliation(s)
- Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.
| | | |
Collapse
|
27
|
Malfait AM, Seymour AB, Gao F, Tortorella MD, Le Graverand-Gastineau MPH, Wood LS, Doherty M, Doherty S, Zhang W, Arden NK, Vaughn FL, Leaverton PE, Spector TD, Hart DJ, Maciewicz RA, Muir KR, Das R, Sorge RE, Sotocinal SG, Schorscher-Petcu A, Valdes AM, Mogil JS. A role for PACE4 in osteoarthritis pain: evidence from human genetic association and null mutant phenotype. Ann Rheum Dis 2012; 71:1042-8. [PMID: 22440827 DOI: 10.1136/annrheumdis-2011-200300] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to assess if genetic variation in the PACE4 (paired amino acid converting enzyme 4) gene Pcsk6 influences the risk for symptomatic knee osteoarthritis (OA). METHODS Ten PCSK6 single nucleotide polymorphisms were tested for association in a discovery cohort of radiographic knee OA (n=156 asymptomatic and 600 symptomatic cases). Meta-analysis of the minor allele at rs900414 was performed in three additional independent cohorts (total n=674 asymptomatic and 2068 symptomatic). Pcsk6 knockout mice and wild-type C57BL/6 mice were compared in a battery of algesiometric assays, including hypersensitivity in response to intraplantar substance P, pain behaviours in response to intrathecal substance P and pain behaviour in the abdominal constriction test. RESULTS In the discovery cohort of radiographic knee OA, an intronic single nucleotide polymorphism at rs900414 was significantly associated with symptomatic OA. Replication in three additional cohorts confirmed that the minor allele at rs900414 was consistently increased among asymptomatic compared to symptomatic radiographic knee OA cases in all four cohorts. A fixed-effects meta-analysis yielded an OR=1.35 (95% CI 1.17 to 1.56; p=4.3×10(-5) and no significant between-study heterogeneity). Studies in mice revealed that Pcsk6 knockout mice were significantly protected against pain in a battery of algesiometric assays. CONCLUSIONS These results suggest that a variant in PCSK6 is strongly associated with protection against pain in knee OA, offering some insight as to why, in the presence of the same structural damage, some individuals develop chronic pain and others are protected. Studies in Pcsk6 null mutant mice further implicate PACE4 in pain.
Collapse
Affiliation(s)
- Anne-Marie Malfait
- Department of Biochemistry/ Internal Medicine, Rush University Medical Center, Chicago, Illinois 60612, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Madry H, Luyten FP, Facchini A. Biological aspects of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2012; 20:407-22. [PMID: 22009557 DOI: 10.1007/s00167-011-1705-8] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 10/04/2011] [Indexed: 01/15/2023]
Abstract
PURPOSE Early OA primarily affects articular cartilage and involves the entire joint, including the subchondral bone, synovial membrane, menisci and periarticular structures. The aim of this review is to highlight the molecular basis and histopathological features of early OA. METHODS Selective review of literature. RESULTS Risk factors for developing early OA include, but are not limited to, a genetic predisposition, mechanical factors such as axial malalignment, and aging. In early OA, the articular cartilage surface is progressively becoming discontinuous, showing fibrillation and vertical fissures that extend not deeper than into the mid-zone of the articular cartilage, reflective of OARSI grades 1.0-3.0. Early changes in the subchondral bone comprise a progressive increase in subchondral plate and subarticular spongiosa thickness. Early OA affects not only the articular cartilage and the subchondral bone but also other structures of the joint, such as the menisci, the synovial membrane, the joint capsule, ligaments, muscles and the infrapatellar fat pad. Genetic markers or marker combinations may become useful in the future to identify early OA and patients at risk. CONCLUSION The high socioeconomic impact of OA suggests that a better insight into the mechanisms of early OA may be a key to develop more targeted reconstructive therapies at this first stage of the disease. LEVEL OF EVIDENCE Systematic review, Level II.
Collapse
Affiliation(s)
- Henning Madry
- Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrbergerstrasse, Building 37, 66421, Homburg, Germany.
| | | | | |
Collapse
|
29
|
Tawonsawatruk T, Changthong T, Pingsuthiwong S, Trachoo O, Sura T, Wajanavisit W. A genetic association study between growth differentiation factor 5 (GDF 5) polymorphism and knee osteoarthritis in Thai population. J Orthop Surg Res 2011; 6:47. [PMID: 21936909 PMCID: PMC3189142 DOI: 10.1186/1749-799x-6-47] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 09/21/2011] [Indexed: 01/29/2023] Open
Abstract
Objective Osteoarthritis (OA) is a multi-factorial disease and genetic factor is one of the important etiologic risk factors. Various genetic polymorphisms have been elucidated that they might be associated with OA. Recently, several studies have shown an association between Growth Differentiation Factor 5(GDF5) polymorphism and knee OA. However, the role of genetic predisposing factor in each ethnic group cannot be replicated to all, with conflicting data in the literatures. Therefore, the aim of this study was to investigate the association between GDF5 polymorphism and knee OA in Thai population. Materials and Methods One hundred and ninety three patients aged 54-88 years who attended Ramathibodi Hospital were enrolled. Ninety cases with knee OA according to American College of Rheumatology criteria and one hundred and three cases in control group gave informed consent. Blood sample (5 ml) were collected for identification of GDF5 (rs143383) single nucleotide polymorphism by PCR/RFLP according to a standard protocol. This study protocol was approved by the Ethics Committee on human experimentation of Ramathibodi Hospital Faculty of Medicine, Mahidol University. Odds ratios (OR) and 95% confidence intervals were calculated for the risk of knee OA by genotype (TT, TC and CC) and allele (T/C) analyses. Results The baseline characteristics between two groups including job, smoking and activity were not different, except age and BMI. The entire cases and controls were in Hardy-Weinberg equilibrium (p > 0.05). The OA knee group (n = 90) had genotypic figure which has shown by TT 42.2% (n = 38), TC 45.6% (n = 41) and CC 12% (n = 11), whereas the control group (n = 103) revealed TT 32% (n = 33), TC 45.6% (n = 47), and CC 22.3% (n = 23), respectively. Genotypic TT increased risk of knee OA as compared to CC [OR = 2.41 (P = 0.04, 95%CI = 1.02-5.67)]. In the allele analysis, the T allele was found to be significantly associated with knee OA [OR = 1.53 (P = 0.043, 95%CI = 1.01-2.30)]. Conclusion These data suggested that GDF5 polymorphism has an association with knee OA in Thai ethnic. This finding also supports the hypothesis that OA has an important genetic component in its etiology, and GDF5 protein might play important role in the pathophysiology of the disease.
Collapse
Affiliation(s)
- Tulyapruek Tawonsawatruk
- Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
| | | | | | | | | | | |
Collapse
|
30
|
Jotanovic Z, Etokebe GE, Mihelic R, Heiland Kårvatn M, Mulac-Jericevic B, Tijanic T, Balen S, Sestan B, Dembic Z. Hip osteoarthritis susceptibility is associated with IL1B -511(G>A) and IL1 RN (VNTR) genotypic polymorphisms in Croatian Caucasian population. J Orthop Res 2011; 29:1137-44. [PMID: 21671260 DOI: 10.1002/jor.21378] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 01/11/2011] [Indexed: 02/04/2023]
Abstract
Among the predisposing factors to osteoarthritis (OA), a frequent destructive joint disease, is the complex genetic heritage including the interleukin-1 family members like the IL1β (IL1B) and the IL1 receptor antagonist (IL1RN) genes. The aim of this study was to investigate allelic and genotypic frequencies of the IL1B gene single nucleotide polymorphism (SNP) at -511(G>A) and the variable number tandem repeat (VNTR) in the IL1RN gene in a Croatian Caucasian population of hip OA (HOA) cases and healthy controls. A total of 259 HOA patients with total hip replacement (THR) and 518 healthy blood donors as controls were genotyped for IL1B gene SNP -511(G>A) and the VNTR in the IL1RN gene associated with HOA. The genotype G/A (1/2) at IL1B was significantly associated with the protection of the HOA (p < 0.036, OR = 0.72, 95% CI = 0.52-0.99). The genotype G/G (1/1) had only a trend towards the susceptibility (p = 0.053, OR = 1.35, 95% CI = 0.98-1.86) to disease. None of the haplotypes IL1B -511(G>A) and IL1RN (VNTR) were found associated with the HOA. The haplotype 1-2 at these loci had only a trend to susceptibility (p = 0.065). Haplotype 1-3 had a significant male bias in diseased. Furthermore, genotype comprising 2-1/2-2 haplotypes was found significantly associated with predisposition to HOA (p = 0.027, OR = 2.23, 95% CI = 1.03-4.88), whereas genotype 1-1/2-2 with protection to disease (p = 0.028, OR = 0.65, 95% CI = 0.43-0.97). Our findings suggest that HOA in Croatian population might have a different genetic risk regarding the IL1 locus than has been reported for other Caucasian populations previously.
Collapse
Affiliation(s)
- Zdravko Jotanovic
- Clinic for Orthopaedic Surgery Lovran, School of Medicine, University of Rijeka, Croatia.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Forestier R, Francon A, Briole V, Genty MC, Chevalier X, Richette P. Diagnostic criteria for generalized osteoarthritis: A preliminary study in a population with knee osteoarthritis. Joint Bone Spine 2011; 78:424-6. [DOI: 10.1016/j.jbspin.2011.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
|
32
|
Weight gain and the risk of total hip replacement a population-based prospective cohort study of 265,725 individuals. Osteoarthritis Cartilage 2011; 19:809-15. [PMID: 21524707 DOI: 10.1016/j.joca.2011.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 03/14/2011] [Accepted: 03/17/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the association between change in the body mass index (BMI) at different ages and the risk of a later total hip replacement (THR) due to primary osteoarthritis (OA). DESIGN A total of 265,725 individuals who had two repeated measurements of weight and height were included from national health screenings. These individuals were followed prospectively. The data were matched with the Norwegian Arthroplasty Register and 4,442 of these individuals were identified as having received a THR for primary OA. Cox proportional hazard regression was used to calculate sex-specific relative risks for having a THR according to age at screening and BMI change. RESULTS Men and women aged 20 years or younger at the first screening in the quartile with the greatest BMI change per year had more than twice the risk of later having a THR compared with those in the quartile with the smallest BMI change per year. For men older than 30 years at the first screening, there was no relationship between BMI gain, or weight gain, and later risk of THR. For older women, BMI gain was associated with risk of THR, but to a lesser degree than in younger women. CONCLUSION There was a clear relationship between change in BMI and the risk of later THR in young men and women, whereas the association was absent in older men and weaker in older women. It is important to focus on weight control to prevent future OA, and the preventive strategy should be focused on the young population.
Collapse
|
33
|
IL1B -511(G>A) and IL1RN (VNTR) allelic polymorphisms and susceptibility to knee osteoarthritis in Croatian population. Rheumatol Int 2011; 32:2135-41. [DOI: 10.1007/s00296-011-1946-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 04/13/2011] [Indexed: 11/25/2022]
|
34
|
Lilley K, Dixon S, Stiles V. A biomechanical comparison of the running gait of mature and young females. Gait Posture 2011; 33:496-500. [PMID: 21292488 DOI: 10.1016/j.gaitpost.2011.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 12/29/2010] [Accepted: 01/05/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Due to health and social advantages, the popularity of running among mature female runners is expanding steadily. However, the incidence of running injuries and associated conditions is vast among this group. This study aimed to quantify gait parameters of mature and younger female runners to assess whether certain running characteristics predispose to debilitating conditions. It was hypothesised that mature females would exhibit greater rearfoot eversion, knee internal rotation, knee external adductor moments and loading rate of ground reaction force when compared to younger runners. METHODS Fifteen mature (40-60 years) and 15 young (18-24 years) females performed 10 running trials at 3.5 m s(-1) in the biomechanics laboratory. Both kinematic and ground reaction force data were collected. Signs of osteoarthritis and knee injuries were assessed using the Knee Osteoarthritis Observation Survey (KOOS) scale. FINDINGS Mature females produced significantly higher peak rearfoot eversion, knee internal rotation, external adductor moment and loading rate of ground reaction force compared to the young participants (p<0.05). INTERPRETATIONS Although all participants recorded "symptom free" on the KOOS scale, all variables of gait found higher among the mature group have previously been associated with development of overuse injuries and debilitating conditions, suggesting a possible predisposition towards these conditions among the mature group.
Collapse
Affiliation(s)
- Kim Lilley
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, Devon, United Kingdom.
| | | | | |
Collapse
|
35
|
Williams FM, Zhai G, Spector TD. Genetics of osteoarthritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
36
|
Abstract
Osteoarthritis (OA) is the most common cause of arthritis and represents an enormous healthcare burden in industrialized societies. Current therapeutic approaches for OA are limited and are insufficient to prevent the initiation and progression of the disease. Genetic studies of patients with OA can help to unravel the molecular mechanisms responsible for specific disease manifestations, including joint damage, nociception and chronic pain. Indeed, these studies have identified molecules, such as growth/differentiation factor 5, involved in signaling cascades that are important for the pathology of joint components. Genome-wide association studies have uncovered a likely role in OA for the genes encoding structural extracellular matrix components (such as DVWA) and molecules involved in prostaglandin metabolism (such as DQB1 and BTNL2). A ∼300 kilobase region in chromosome 7q22 is also associated with OA susceptibility. Finally, the identification of individuals at a high risk of OA and of total joint arthroplasty failure might be facilitated by the use of combinations of genetic markers, allowing for the application of preventive and disease-management strategies.
Collapse
|
37
|
Valdes AM, McWilliams D, Arden NK, Doherty SA, Wheeler M, Muir KR, Zhang W, Cooper C, Maciewicz RA, Doherty M. Involvement of different risk factors in clinically severe large joint osteoarthritis according to the presence of hand interphalangeal nodes. ACTA ACUST UNITED AC 2010; 62:2688-95. [PMID: 20499385 DOI: 10.1002/art.27574] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To quantify the differences in risk factors influencing total hip replacement (THR) and total knee replacement (TKR) based on the presence versus absence of multiple interphalangeal nodes in 2 or more rays of the fingers of each hand in patients with large joint osteoarthritis (OA). METHODS A group of 3,800 patients with large joint OA who underwent total joint replacement (1,201 of whom had the nodal phenotype) and 1,906 control subjects from 2 case-control studies and a population-based cohort in the UK were studied. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for the risk of total joint replacement in association with age, sex, body mass index (BMI), height, and prevalence of the T allele in the GDF5 rs143383 polymorphism. ORs for total joint replacement were compared between cases of nodal OA and cases of non-nodal OA and between patients who underwent TKR and those who underwent THR. RESULTS Age, sex, and BMI had significantly higher ORs for an association with total joint replacement in nodal OA cases than in non-nodal OA cases. The GDF5 polymorphism was significantly associated with THR in cases of nodal OA, but not in cases of non-nodal OA, and increased height was a risk factor for THR in non-nodal OA cases only. Female sex was a protective risk factor for TKR in non-nodal OA cases (OR 0.60, 95% CI 0.52-0.70) but was predisposing for TKR in the nodal form of OA (OR 1.83, 95% CI 1.49-2.26). The nodal phenotype was associated with a significantly higher risk of undergoing both THR and TKR (OR 1.46, 95% CI 1.09-1.94) and also a significantly higher risk of bilateral TKR (OR 1.70, 95% CI 1.37-2.11), but, paradoxically, was associated with a lower risk of bilateral THR (OR 0.72, 95% CI 0.56-0.91). CONCLUSION Nodal and non-nodal forms of large joint OA have significantly different risk factors and outcomes, indicating a different etiology for the 2 forms of OA. With regard to the likelihood of undergoing THR, this appears to be, at least in part, genetically determined.
Collapse
Affiliation(s)
- Ana M Valdes
- Department of Twin Research and Genetic Epidemiology, King's College London and St. Thomas' Hospital, London, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Pollard TCB, McNally EG, Wilson DC, Wilson DR, Mädler B, Watson M, Gill HS, Carr AJ. Localized cartilage assessment with three-dimensional dGEMRIC in asymptomatic hips with normal morphology and cam deformity. J Bone Joint Surg Am 2010; 92:2557-69. [PMID: 21048174 DOI: 10.2106/jbjs.i.01200] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cam deformities cause femoroacetabular impingement and damage the acetabular labral-chondral complex. The aims of this study were to investigate the potential of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) to detect cartilage disease in asymptomatic hips with cam deformities compared with morphologically normal hips, establish whether dGEMRIC could identify advanced disease in hips with positive clinical findings, and establish whether cartilage damage correlated with the severity of the cam deformity. METHODS Subjects were recruited from a prospective study of individuals with a family history of osteoarthritis and their spouses who served as control subjects. Their symptoms and impingement test results were recorded. Asymptomatic hips with normal radiographic joint-space width were placed in a subgroup according to the presence of a cam deformity and the impingement test result. dGEMRIC was performed on a 3-T system, studying two regions of interest: the anterosuperior aspect of the acetabular cartilage (T1(acet)) and the total femoral and acetabular cartilage (T1(total)). The ratio T1(acet)/T1(total) gave the relative glycosaminoglycan content in the anterosuperior aspect of the acetabular cartilage. The cohort was placed in subgroups by joint morphology, impingement test status, and genetic predisposition; the mean T1 scores were compared, and the alpha angle and T1 were correlated. RESULTS Of thirty-two subjects (mean age, fifty-two years), nineteen had cam deformities. Hips with a cam deformity had reduced acetabular glycosaminoglycan content compared with normal hips (mean T1(acet)/T1(total), 0.949 and 1.093, respectively; p = 0.0008). Hips with a positive impingement test result had global depletion of glycosaminoglycan compared with hips with a negative result (mean T1(total), 625 ms versus 710 ms; p = 0.0152). T1(acet) inversely correlated with the magnitude of the alpha angle (r = -0.483, p = 0.0038), suggesting that the severity of cartilage damage correlates with the magnitude of the cam deformity. All of these differences occurred irrespective of genetic predisposition. CONCLUSIONS The dGEMRIC technique can detect cartilage damage in asymptomatic hips with cam deformities and no radiographic evidence of joint space narrowing. This damage correlates with cam deformity severity. Further study of the application of dGEMRIC as an imaging biomarker of early osteoarthritis is justified to validate its prognostic accuracy, identify subjects for clinical trials, and evaluate the effectiveness of surgical procedures.
Collapse
Affiliation(s)
- T C B Pollard
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Valdes AM, Spector TD. The clinical relevance of genetic susceptibility to osteoarthritis. Best Pract Res Clin Rheumatol 2010; 24:3-14. [PMID: 20129195 DOI: 10.1016/j.berh.2009.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Osteoarthritis is a major musculoskeletal cause of disability in the elderly, but current therapeutic approaches are insufficient to prevent initiation and progression of the disease. Genetic studies in humans have identified molecules involved in signalling cascades that are important for the pathology of the joint components. These include the bone morphogenetic protein (BMP) signalling, the wingless-type signalling and the thyroid pathway as well as apoptotic-related molecules. There is emerging evidence indicating that inflammatory molecules related to cytokine production, prostaglandin and arachidonic acid metabolism are also involved in susceptibility to osteoarthritis. All of these pathways are likely targets for pharmacological intervention. Genetic variation also affects pain due to osteoarthritis highlighting molecular mechanisms for pain relief. Moreover, combinations of genetic markers can be used to identify individuals at high risk of osteoarthritis and risk of total joint arthroplasty failure, which should facilitate the application of preventive and disease management strategies.
Collapse
Affiliation(s)
- Ana M Valdes
- Department of Twin Research, St. Thomas' Hospital Campus, Kings College London School of Medicine, Westminster Bridge Road, London SE1 7EH, UK.
| | | |
Collapse
|
41
|
Pollard TCB, Villar RN, Norton MR, Fern ED, Williams MR, Murray DW, Carr AJ. Genetic influences in the aetiology of femoroacetabular impingement: a sibling study. ACTA ACUST UNITED AC 2010; 92:209-16. [PMID: 20130310 DOI: 10.1302/0301-620x.92b2.22850] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Femoroacetabular impingement causes pain in the hip in young adults and may predispose to the development of osteoarthritis. Genetic factors are important in the aetiology of osteoarthritis of the hip and may have a role in that of femoroacetabular impingement. We compared 96 siblings of 64 patients treated for primary impingement with a spouse control group of 77 individuals. All the subjects were screened clinically and radiologically using a standardised protocol for the presence of cam and pincer deformities and osteoarthritis. The siblings of those patients with a cam deformity had a relative risk of 2.8 of having the same deformity (66 of 160 siblings hips versus 23 of 154 control hips, p < 0.00001). The siblings of those patients with a pincer deformity had a relative risk of 2.0 of having the same deformity (43 of 116 sibling hips versus 29 of 154 control hips, p = 0.001). Bilateral deformity occurred more often in the siblings (42 of 96 siblings versus 13 of 77 control subjects, relative risk 2.6, p = 0.0002). The prevalence of clinical features in those hips with abnormal morphology was also greater in the sibling group compared with the control group (41 of 109 sibling hips versus 7 of 46 control hips, relative risk 2.5, p = 0.007). In 11 sibling hips there was grade-2 osteoarthritis according to Kellgren and Lawrence versus none in the control group (p = 0.002). Genetic influences are important in the aetiology of primary femoroacetabular impingement. This risk appears to be manifested through not only abnormal joint morphology, but also through other factors which may modulate progression of the disease.
Collapse
Affiliation(s)
- T C B Pollard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Headington, Oxford OX3 7LD, UK.
| | | | | | | | | | | | | |
Collapse
|
42
|
Valdes AM. Molecular pathogenesis and genetics of osteoarthritis: implications for personalized medicine. Per Med 2010; 7:49-63. [DOI: 10.2217/pme.09.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
43
|
Valdes AM, Lories RJ, van Meurs JB, Kerkhof H, Doherty S, Hofman A, Hart DJ, Zhang F, Luyten FP, Uitterlinden AG, Doherty M, Spector TD. Variation at the ANP32A gene is associated with risk of hip osteoarthritis in women. ACTA ACUST UNITED AC 2009; 60:2046-54. [DOI: 10.1002/art.24627] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
44
|
Limer KL, Tosh K, Bujac SR, McConnell R, Doherty S, Nyberg F, Zhang W, Doherty M, Muir KR, Maciewicz RA. Attempt to replicate published genetic associations in a large, well-defined osteoarthritis case-control population (the GOAL study). Osteoarthritis Cartilage 2009; 17:782-9. [PMID: 19036616 DOI: 10.1016/j.joca.2008.09.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 09/27/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Published studies have tested over 90 genes for association with osteoarthritis (OA), but few positives reported have been independently replicated. Using a new case-control study, our aim was to attempt the replication of findings from 12 genes reported to have significant genetic association with OA and to further examine the role of genetic variation in six of these genes. METHODS A case-control study was undertaken in Nottingham, UK. Hospital-referred index cases with symptomatic, radiographic OA (ROA) of the knee (n=1040) or hip (n=1004) were recruited. Asymptomatic controls (n=1123) were recruited from intravenous urography waiting lists and screened for radiographic hip and knee OA. Sixty-eight polymorphisms were genotyped in IL1A, IL1B, IL1RN, IL4R, IL6, COL2A1, ADAM12, ASPN, IGF1, TGFB1, ESR1 and VDR. Statistical analysis compared allele or genotype frequencies of these polymorphisms in all asymptomatic controls and the subset of controls without ROA vs all OA, knee OA and hip OA. The analyses were adjusted for age, gender and body mass index. RESULTS We were unable to replicate any of the published genetic associations investigated. Our extended exploratory analyses identified some associations between polymorphisms in TGFB1, IGF1 and IL1RN and OA; but the strength of evidence varied with the control group used. CONCLUSION Lack of replication is common and could be due to differences in study design, phenotype, populations examined or the occurrence of false positives in the initial study. Variants within TGFB1, IGF1 and IL1RN could have a role in OA susceptibility; however, replication of these findings is required in an independent study.
Collapse
Affiliation(s)
- K L Limer
- Department of Public Health and Epidemiology, Nottingham University Medical School, Nottingham NG7 2UH, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Hip pain and mobility deficits--hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2009; 39:A1-25. [PMID: 19352008 PMCID: PMC3963282 DOI: 10.2519/jospt.2009.0301] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
46
|
Abstract
Osteoarthritis (OA) is the most prevalent form of arthritis in the elderly. A large body of evidence, including familial aggregation and classic twin studies, indicates that primary OA has a strong hereditary component that is likely polygenic in nature. Traits related to OA, such as longitudinal changes in cartilage volume and progression of radiographic features, are also under genetic control. In recent years several linkage analyses and candidate gene studies have been performed and unveiled some of the specific genes involved in disease risk, such as FRZB and GDF5. This article discusses the impact that future genome-wide association scans can have on our understanding of the pathogenesis of OA and on identifying individuals at high risk for developing severe OA.
Collapse
Affiliation(s)
- Ana M Valdes
- Twin Research and Genetic Epidemiology Unit, St. Thomas Hospital Campus, Kings College, London School of Medicine, London SE1 7EH, UK.
| | | |
Collapse
|
47
|
Doherty M, Courtney P, Doherty S, Jenkins W, Maciewicz RA, Muir K, Zhang W. Nonspherical femoral head shape (pistol grip deformity), neck shaft angle, and risk of hip osteoarthritis: a case-control study. ACTA ACUST UNITED AC 2008; 58:3172-82. [PMID: 18821698 DOI: 10.1002/art.23939] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether 2-dimensional measures of femoral head shape and angle are associated with hip osteoarthritis (OA). METHODS We compared cases with symptomatic radiographic hip OA with asymptomatic controls with no radiographic hip OA. On anteroposterior pelvis radiographs, we measured "pistol grip deformity" for each hip (visually categorized as nonspherical, indeterminate, or spherical), the femoral head-to-femoral neck ratio as an interval measure of femoral head shape, and the femoral neck shaft angle. The relative risk of hip OA associated with each feature was estimated using odds ratios (ORs) and 95% confidence intervals (95% CIs), adjusted for possible confounders using a logistic regression model. RESULTS Of 1,007 cases, 965 had definite radiographic hip OA; of 1,123 controls, 1,111 had no radiographic OA. The prevalence of pistol grip deformity in at least 1 hip was 3.61% in controls and 17.71% in cases (OR 6.95 [95% CI 4.64-10.41]), and the prevalence of abnormal femoral head-to-femoral neck ratio in at least 1 hip was 3.70% in controls and 24.27% in cases (OR 12.08 [95% CI 8.05-18.15]). The risk of hip OA increased as the femoral head-to-femoral neck ratio decreased (P for trend<0.001) and with each extreme of neck shaft angle (P<0.05). In cases with unilateral hip OA, the prevalence of abnormal femoral head-to-femoral neck ratio in the unaffected hip was 2 times greater than that in controls (OR 1.82 [95% CI 1.07-3.07]); in contrast, an abnormally low, but not abnormally high, neck shaft angle was more common in unaffected hips than in controls (OR 1.79 [95% CI 1.03-3.14]). CONCLUSION Our findings indicate that pistol grip deformity is associated with hip OA. The increased prevalence of pistol grip deformity and an abnormally low neck shaft angle in unaffected hips of cases with unilateral OA suggests that they are risk factors for development of hip OA. However, both a nonspherical head shape and an increase in neck shaft angle may occur as a consequence of OA.
Collapse
Affiliation(s)
- Michael Doherty
- University of Nottingham, Nottingham University Hospitals Trust, Nottingham, UK.
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Osteoarthritis (OA) is the most prevalent form of arthritis in the elderly. A large body of evidence, including familial aggregation and classic twin studies, indicates that primary OA has a strong hereditary component that is likely polygenic in nature. Furthermore, traits related to OA, such as longitudinal changes in cartilage volume and progression of radiographic features, are also under genetic control. In recent years, several linkage analysis and candidate gene studies have been performed and have unveiled some of the specific genes involved in disease risk, such as FRZB and GDF5. The authors discuss the impact that future genome-wide association scans can have on our understanding of the pathogenesis of OA and on identifying individuals at high risk for developing severe OA.
Collapse
Affiliation(s)
- Ana M Valdes
- Twin Research & Genetic Epidemiology Unit, St. Thomas' Hospital Campus, Kings College London School of Medicine, London SE1 7EH, UK.
| | | |
Collapse
|
49
|
Mechlenburg I. Evaluation of Bernese periacetabular osteotomy: prospective studies examining projected load-bearing area, bone density, cartilage thickness and migration. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2008; 79:4-43. [PMID: 18853289 DOI: 10.1080/17453690610046558] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The typical dysplastic hip joint is characterised by maldirection of the acetabulum and femoral neck, insufficient coverage of the femoral head focally and globally and erosions of the limbus acetabuli (1). An unknown number of persons with hip dysplasia will suffer from pain in hip or groin, decreased hip function and development of osteoarthritis at a young age. The Bernese periacetabular osteotomy is performed to prevent osteoarthritis in patients with hip dysplasia and has been carried out at Aarhus University Hospital, Denmark since 1996 with more than 500 osteotomies performed. Throughout the years, research and quality improvement of the treatment has taken place and this PhD thesis is part of that process. The aims of this PhD thesis were to evaluate outcome aspects after periacetabular osteotomy in terms of I) estimating the projected loadbearing surface before and after periacetabular osteotomy, II) estimating bone density changes in the acetabulum after periacetabular osteotomy, III) developing a technique to precisely and efficiently estimate the thickness of the articular cartilage in the hip joint and IV) examining the stability of the re-orientated acetabulum after periacetabular osteotomy. In study I, we applied a stereologic method based on 3D computed tomography (CT) to estimate the projected loadbearing surface in six normal hip joints and in six dysplastic hips. The dysplastic hips were CT scanned before and after periacetabular osteotomy. We found that the average area of the projected loadbearing surface of the femoral head preoperatively was 7.4 (range 6.5-8.4) cm2 and postoperatively 11 (9.8-14.3) cm2. The area of the projected loadbearing surface was increased significantly with a mean of 49% (34-70%) postoperatively and thus comparable with the load-bearing surface in the normal control group. Double measurements were performed and the error variance of the mean was estimated to be 1.6%. The effect of overprojection, on the projected loadbearing surface was minimal. Consequently, the stereo-logic method proved to be precise and unbiased. The study indicates that this method is applicable in monitoring the loadbearing area in the hip joint of patients undergoing periacetabular osteotomy. In study II, a method based on CT and 3D design-based sampling principles was used to estimate bone density in different regions of the acetabulum. Baseline density was measured within the first seven days following periacetabular osteotomy and compared with density two years postoperatively. Double measurements were performed on three patients, and the error variance was estimated to be 0.05. Six patients with hip dysplasia scheduled for periacetabular osteotomy were consecutively included in the study. Bone density increased significantly in the anteromedial quadrant of the acetabulum as well as in the posteromedial quadrant between the two time-points. In the anterolateral quadrant bone density was unchanged following surgery, and the same was true for the posterolateral quadrant. We suggest that the observed increase in bone density medially represents a remodelling response to an altered load distribution after periacetabular osteotomy. The described method is a precise tool to estimate bone density changes in the acetabulum. Study III. As periacetabular osteotomy is performed on dysplastic hips to prevent osteoarthritic progression, changes in the thickness of the articular cartilage is a central variable to follow over time. 26 dysplastic hips on 22 females and 4 males were magnetic resonance imaged (MRI) preoperatively. The first 13 patients were examined twice, with complete repositioning of the patient and set-up in order to obtain an estimate of the precision of the method used. To show the acetabular and femoral cartilages separately, an ankle traction device was used during MRI. This device pulled the leg distally with a load of 10 kg. The mean thickness of the acetabular cartilage was 1.26 mm, SD 0.04 mm. The mean thickness of the femoral cartilage was 1.18 mm, SD 0.06. The precision calculated as the error variance was estimated for the thickness of the acetabular cartilage to 0.01 and femoral cartilage 0.02. We suggest that the method can be advantageous for assessing the progression of osteoarthritis in dysplastic hips after periacetabular osteotomy. In study IV, 32 dysplastic hips, 27 females and 5 males were included in the study. Radiostereometric examinations (RSA) were done at one week, four weeks, eight weeks and six months. Data are presented as mean + SD. Six months postoperatively, the acetabular fragment had migrated 0.7 mm + 0.8 medially, and 0.7 mm + 0.5 proximally. Mean rotation in adduction was 0.5 degrees + 1.3. In other directions, mean migration was below 0.5 mm/degrees. There was no statistical difference between migration 8 weeks and 24 weeks postoperatively in translation or rotation. Due to the limited migration, we find our postoperative partial weight-bearing regime safe. In conclusion, the studies in the present PhD thesis indicate that the projected loadbearing area of the hip joint increases considerable in patients undergoing periacetabular osteotomy and a method to estimate this area was described. Bone density increases in the medial quadrants two years postoperative and a method is developed to precisely estimate bone density on CT images. Also a method to precisely estimate cartilage thickness was presented and we suggest that the method can be advantageous for assessing the progression of osteoarthritis in dysplastic hips after periacetabular osteotomy. Due to the very limited migration of the acetabular fragment fixated with two screws, we find our fixation sufficient and the postoperative partial weight-bearing regimen safe.
Collapse
|
50
|
Acetabular dysplasia as an aetiological factor in development of hip osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2008; 33:653-7. [PMID: 18478228 DOI: 10.1007/s00264-008-0554-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 02/27/2008] [Accepted: 02/28/2008] [Indexed: 10/22/2022]
Abstract
The objective of this study was to investigate the relation between acetabular dysplasia (AD) of the hip and risk for development of hip osteoarthritis (OA) in a Sámi population with very high prevalence of AD (38%). A population-based survey was conducted in a main Sámi area in Norway. A total of 315 middle-aged subjects were examined clinically and radiologically and were regarded as a random sample of 836 responders from a general health survey. The results demonstrated that 6.8% of the Sámi population had OA. The logistic regression analyses did not show a significant association between AD and OA. Only age had a statistically significant influence on OA. In this middle-aged Sámi population, there is no evidence for the influence of AD on the development of hip OA.
Collapse
|