Predictors of total hip replacement in community based older adults: a cohort study
Predictors of total hip replacement in community based older adults: a cohort study
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DOI：
10.1016/j.joca.2021.04.013
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发表时间：
2021-07-23
影响因子：
7
通讯作者：
Jones, G.
中科院分区：
文献类型：
--
作者：
Mezhov, V.;Laslett, L. L.;Jones, G.
目的：本研究的目的是描述社区老年人全髋关节置换术（THR）的预测因素。更好地了解THR的预测因素有助于对患者进行分类和研究预防策略。设计图：在基线时，参与者评估放射学OA和凸轮形态（来自骨盆X线片），形状模式评分和髋部骨矿物质密度（BMD;来自双能X线吸收测定法（DXA））。2.6年和5年后，参与者使用WOMAC（西安大略和麦克马斯特大学骨关节炎指数）报告髋关节疼痛，并使用磁共振成像（MRI）评估髋关节结构变化。使用混合效应泊松回归分析THR的风险。结果：14年以上OA的THR发生率为4.6%（37/801）。正如预期的那样，WOMAC髋关节疼痛和髋关节放射学OA均预测THR的风险。此外，形状模式2评分（髋臼覆盖率降低）（RR 1.83/SD; 95% CI 1.1-3.04），形状模式4分（非球形股骨头）（RR 0.59/SD; 95% CI 0.36 - 0.96），凸轮形态（a > 60度）（RR 2.2/SD; 95% CI 1.33-3.36），股骨颈BMD（RR 2.09/SD，95% CI 1.48 - 2.94）和骨髓病变（BML）增加THR的风险（RR 7.10/单位; 95% CI 1.09-46.29）。结论：除了髋关节疼痛和影像学髋关节OA外，髋关节形状、凸轮形态、BMD和BML的测量可独立预测THR的风险。这支持了髋骨几何形状和结构在终末期髋关节OA发病机制中的作用，并确定了可用于改善THR预测模型的因素。(c)2021国际骨关节炎研究学会。由爱思唯尔有限公司出版。保留所有权利。
Objective: The purpose of this study is to describe predictors of total hip replacement (THR) in community dwelling older adults. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. Design: At baseline, participants had assessment of radiographic OA and cam morphology (from pelvic radiographs), shape mode scores and hip bone mineral density (BMD; from dual energy X-ray absorptiometry (DXA)). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression. Results: Incidence of THR for OA over 14 years was 4.6% (37/801). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.83/SD; 95% CI 1.1-3.04), shape mode 4 score (non-spherical femoral head) (RR 0.59/SD; 95% CI 0.36 -0.96), cam morphology (a > 60 degrees) (RR 2.2/SD; 95% CI 1.33-3.36), neck of femur BMD (RR 2.09/SD, 95% CI 1.48 -2.94) and bone marrow lesions (BMLs) increased risk of THR (RR 7.10/unit; 95% CI 1.09-46.29). Conclusion: In addition to hip pain and radiographic hip OA, measures of hip shape, cam morphology, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR. (c) 2021 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.