Variations in Hip Morphology: Frequency and Impact on Osteoarthritis Outcomes

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DESCRIPTION (provided by applicant): The candidate is a rheumatologist with a foundation in clinical research and epidemiologic methods, and a strong interest in novel imaging techniques as applied to osteoarthritis (OA). The candidate's long-term career goal is to become an independently funded, academic clinician-scientist, with a broad research focus on OA, and particular emphasis on advanced imaging and multiple joint involvement in OA. The candidate's short- term career goals are to 1) design a protocol for and gain practical experience with radiographic estimates of hip morphology (including femoroacetabular impingement [FAI], and hip shape by active shape models), 2) obtain specialized didactic training in advanced epidemiologic and statistical methods, 3) learn to collaborate with other large ongoing cohorts, 4) collect data, establish networks, and amass the necessary publication track record needed to compete for independent funding, and 5) obtain additional training in the Responsible Conduct of Research. The proposed research plan, career development activities, mentorship plan, advisory panel, and institutional environment are well suited to assist the applicant in achieving these goals. The rationale for the proposed research is that knowledge of the frequency and clinical impact of alterations in hip shape (including FAI), and the effects of such alterations on the development of OA, is essential to allow informed policy and clinical decisions regarding diagnostic and therapeutic interventions for hip OA. In Aim 1, the PI will assess the prevalence of radiographic findings of FAI in a large population-based cohort, and in Aim 2 will determine associations between these findings and validated clinical outcomes. Aim 3 will allow the PI to determine whether hip morphology (by FAI or active shape modes) predicts incident radiographic or symptomatic hip outcomes. The expected result of this proposal will be an improved knowledge of the prevalence and clinical importance of hip morphology in the development of hip OA. To support the candidate's career development, she will pursue coursework in advanced data analysis methods and research ethics, along with practical training in specialized imaging methods and interpretation. The advisory team, which includes multi-disciplinary collaborators with a wide range of expertise (Renner, Schwartz, DeVellis, and Helmick) as well as internationally-recognized, independently-funded investigators with expertise in OA epidemiology (Jordan) and imaging and shape assessments in OA (Kraus, Lane, and Aspden), will guide Dr. Nelson's research and career development. The research environment will provide a productive, collegial, and collaborative atmosphere in which Dr. Nelson can pursue her research and training goals. PUBLIC HEALTH RELEVANCE: An estimated 27 million adults in the United States have osteoarthritis, a debilitating chronic joint disease that can affect one or more joint sites, most commonly the hands, knees, hips, and/or spine, leading to substantial morbidity. Despite the large burden of this condition, particularly in weight-bearing joints, there are no disease modifying treatments available to treat or prevent joint damage in OA. The goal of this and subsequent research is to assess potential unique risk factors for OA at the hip, which may lead to specific diagnostic and therapeutic interventions, thereby reducing disability from hip OA.