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Bugeja JM, Xia Y, Chandra SS, Murphy NJ, Crozier S, Hunter DJ, Fripp J, Engstrom C. Analysis of cam location characteristics in FAI syndrome patients from 3D MR images demonstrates sex-specific differences. J Orthop Res 2024; 42:385-394. [PMID: 37525546 DOI: 10.1002/jor.25674] [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: 03/01/2023] [Revised: 06/22/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
Cam femoroacetabular impingement (FAI) syndrome is associated with hip osteoarthritis (OA) development. Hip shape features, derived from statistical shape modeling (SSM), are predictive for OA incidence, progression, and arthroplasty. Currently, no three-dimensional (3D) SSM studies have investigated whether there are cam shape differences between male and female patients, which may be of potential clinical relevance for FAI syndrome assessments. This study analyzed sex-specific cam location and shape in FAI syndrome patients from clinical magnetic resonance examinations (M:F 56:41, age: 16-63 years) using 3D focused shape modeling-based segmentation (CamMorph) and partial least squares regression to obtain shape features (latent variables [LVs]) of cam morphology. Two-way analysis of variance tests were used to assess cam LV data for sex and cam volume severity differences. There was no significant interaction between sex and cam volume severity for the LV data. A sex main effect was significant for LV 1 (cam size) and LV 2 (cam location) with medium to large effect sizes (p < 0.001, d > 0.75). Mean results revealed males presented with a superior-focused cam, whereas females presented with an anterior-focused cam. When stratified by cam volume, cam morphologies were located superiorly in male and anteriorly in female FAI syndrome patients with negligible, mild, or moderate cam volumes. Both male and female FAI syndrome patients with major cam volumes had a global cam distribution. In conclusion, sex-specific cam location differences are present in FAI syndrome patients with negligible, mild, and moderate cam volumes, whereas major cam volumes were globally distributed in both male and female patients.
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Affiliation(s)
- Jessica M Bugeja
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Ying Xia
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Shekhar S Chandra
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, QLD, Australia
| | - Nicholas J Murphy
- Kolling Institute of Medical Research, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | - Stuart Crozier
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, QLD, Australia
| | - David J Hunter
- Kolling Institute of Medical Research, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jurgen Fripp
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Craig Engstrom
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
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Heppenstall SV, Ebsim R, Saunders FR, Lindner C, Gregory JS, Aspden RM, Harvey NC, Cootes T, Tobias JH, Frysz M, Faber BG. Hip geometric parameters are associated with radiographic and clinical hip osteoarthritis: Findings from a cross-sectional study in UK Biobank. Osteoarthritis Cartilage 2023; 31:1627-1635. [PMID: 37704099 PMCID: PMC7615936 DOI: 10.1016/j.joca.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To examine the extent to which geometric parameters derived from dual-energy x-ray absorptiometry (DXA) scans in the UK Biobank study are related to hip osteoarthritis (HOA) independently of sex, age and body size. DESIGN Femoral neck width (FNW), diameter of the femoral head (DFH) and hip axis length (HAL) were derived automatically from left hip DXA scans in UK Biobank using outline points placed around the hip by a machine-learning program. Correlations were calculated between geometric parameters, age, height, and weight. Logistic regression was used to examine the relationship of geometric parameters with radiographic HOA, hospital diagnosed HOA (HESOA), and Cox proportional hazards model to evaluate the relationship with total hip replacement (THR). Analyses were adjusted for sex, age, height, weight, and geometric parameters. RESULTS The study consisted of 40,312 participants. In age and sex-adjusted analyses, FNW, HAL and DFH were related to increased risk of radiographic HOA. In a model adjusted for age, sex, height, weight and other geometric parameters, both FNW and HAL retained independent relationships with radiographic HOA [FNW: odds ratios 2.38 (2.18-2.59), HAL: 1.25 (1.15-1.36)], while DFH was now protective [0.55 (0.50-0.61)]. Only FNW was independently related to HESOA [2.20 (1.80-2.68)] and THR [hazard ratios 2.51 (1.89-3.32)]. CONCLUSION Greater FNW and HAL were independently related to an increased risk of radiographic HOA, whereas greater DFH appeared to be protective. Greater FNW was independently associated with HESOA and THR. These results suggest that DXA-derived geometric parameters, particularly FNW, could help determine HOA and THR risk.
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Affiliation(s)
| | - R Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - F R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - C Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - N C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - T Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - M Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - B G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK.
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Zheng J, Frysz M, Faber BG, Lin H, Ebsim R, Ge J, Yong Y, Saunders FR, Gregory JS, Aspden RM, Harvey NC, Jiang BH, Cootes T, Lindner C, Gao X, Wang S, Tobias JH. Comparison between UK Biobank and Shanghai Changfeng suggests distinct hip morphology may contribute to ethnic differences in the prevalence of hip osteoarthritis. Osteoarthritis Cartilage 2023:S1063-4584(23)00958-5. [PMID: 37935324 DOI: 10.1016/j.joca.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
OBJECTS Joint morphology is a risk factor for hip osteoarthritis (HOA) and could explain ethnic differences in HOA prevalence. Therefore, we aimed to compare the prevalence of radiographic HOA (rHOA) and hip morphology between the predominantly White UK Biobank (UKB) and exclusively Chinese Shanghai Changfeng (SC) cohorts. METHODS Left hip iDXA scans were used to quantify rHOA, from a combination of osteophytes (grade ≥1) and joint space narrowing (grade ≥1), and hip morphology. Using an 85-point Statistical Shape Model (SSM) we evaluated cam (alpha angle ≥60°) and pincer (lateral centre-edge angle (LCEA) ≥45°) morphology and acetabular dysplasia (LCEA <25°). Diameter of femoral head (DFH), femoral neck width (FNW), and hip axis length (HAL) were also obtained from these points. Results were adjusted for differences in age, height, and weight and stratified by sex. RESULTS Complete data were available for 5924 SC and 39,020 White UKB participants with mean ages of 63.4 and 63.7 years old. rHOA prevalence was considerably lower in female (2.2% versus 13.1%) and male (12.0% and 25.1%) SC compared to UKB participants. Cam morphology, rarely seen in females, was less common in SC compared with UKB males (6.3% versus 16.5%). Composite SSM modes, scaled to the same overall size, revealed SC participants to have a wider femoral head compared to UKB participants. FNW and HAL were smaller in SC compared to UKB, whereas DFH/FNW ratio was higher in SC. CONCLUSIONS rHOA prevalence is lower in Chinese compared with White individuals. Several differences in hip shape were observed, including frequency of cam morphology, FNW, and DFH/FNW ratio. These characteristics have previously been identified as risk factors for HOA and may contribute to observed ethnic differences in HOA prevalence.
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Affiliation(s)
- Jiayi Zheng
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China; Fudan Institute for Metabolic Diseases, Shanghai, China
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Jieyu Ge
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yanling Yong
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bing-Hua Jiang
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China; Fudan Institute for Metabolic Diseases, Shanghai, China.
| | - Sijia Wang
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China.
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
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Johnson LG, Bortolussi-Courval S, Chehil A, Schaeffer EK, Pawliuk C, Wilson DR, Mulpuri K. Application of statistical shape modeling to the human hip joint: a scoping review. JBI Evid Synth 2023; 21:533-583. [PMID: 36705052 PMCID: PMC9994808 DOI: 10.11124/jbies-22-00175] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective of this scoping review was to identify all examples of the application of statistical shape models to the human hip joint, with a focus on applications, population, methodology, and validation. INTRODUCTION Clinical radiographs are the most common imaging tool for management of hip conditions, but it is unclear whether radiographs can adequately diagnose or predict outcomes of 3D deformity. Statistical shape modeling, a method of describing the variation of a population of shapes using a small number of variables, has been identified as a useful tool to associate 2D images with 3D anatomy. This could allow clinicians and researchers to validate clinical radiographic measures of hip deformity, develop new ones, or predict 3D morphology directly from radiographs. In identifying all previous examples of statistical shape modeling applied to the human hip joint, this review determined the prevalence, strengths, and weaknesses, and identified gaps in the literature. INCLUSION CRITERIA Participants included any human population. The concept included development or application of statistical shape models based on discrete landmarks and principal component analysis. The context included sources that exclusively modeled the hip joint. Only peer-reviewed original research journal articles were eligible for inclusion. METHODS We searched MEDLINE, Embase, Cochrane CENTRAL, IEEE Xplore, Web of Science Core Collection, OCLC PapersFirst, OCLC Proceedings, Networked Digital Library of Theses and Dissertations, ProQuest Dissertations and Theses Global, and Google Scholar for sources published in English between 1992 and 2021. Two reviewers screened sources against the inclusion criteria independently and in duplicate. Data were extracted by 2 reviewers using a REDCap form designed to answer the review study questions, and are presented in narrative, tabular, and graphical form. RESULTS A total of 104 sources were considered eligible based on the inclusion criteria. From these, 122 unique statistical shape models of the human hip were identified based on 86 unique training populations. Models were most often applied as one-off research tools to describe shape in certain populations or to predict outcomes. The demographics of training populations were skewed toward older patients in high-income countries. A mean age between 60 and 79 years was reported in 29 training populations (34%), more than reported in all other age groups combined, and 73 training populations (85%) were reported or inferred to be from Europe and the Americas. Only 4 studies created models in a pediatric population, although 15 articles considered shape variation over time in some way. There were approximately equal numbers of 2D and 3D models. A variety of methods for labeling the training set was observed. Most articles presented some form of validation such as reporting a model's compactness (n = 71), but in-depth validation was rare. CONCLUSIONS Despite the high volume of literature concerning statistical shape models of the human hip, there remains a need for further research in key areas. We identified the lack of models in pediatric populations and low- and middle-income countries as a notable limitation to be addressed in future research.
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Affiliation(s)
- Luke G Johnson
- School of Biomedical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Sara Bortolussi-Courval
- School of Biomedical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada.,Department of Mechanical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada
| | - Anjuli Chehil
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emily K Schaeffer
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Colleen Pawliuk
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - David R Wilson
- Centre for Hip Health and Mobility, Vancouver, BC, Canada.,Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kishore Mulpuri
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
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5
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Appleyard T, Thomas MJ, Antcliff D, Peat G. Prediction Models to Estimate the Future Risk of Osteoarthritis in the General Population: A Systematic Review. Arthritis Care Res (Hoboken) 2022. [PMID: 36205228 DOI: 10.1002/acr.25035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/06/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the performance and applicability of multivariable prediction models for osteoarthritis (OA). METHODS This was a systematic review and narrative synthesis using 3 databases (EMBASE, PubMed, and Web of Science) from inception to December 2021. We included general population longitudinal studies reporting derivation, comparison, or validation of multivariable models to predict individual risk of OA incidence, defined by recognized clinical or imaging criteria. We excluded studies reporting prevalent OA and joint arthroplasty outcome. Paired reviewers independently performed article selection, data extraction, and risk-of-bias assessment. Model performance, calibration, and retained predictors were summarized. RESULTS A total of 26 studies were included, reporting 31 final multivariable prediction models for incident knee (23), hip (4), hand (3) and any-site OA (1), with a median of 121.5 (range 27-12,803) outcome events, a median prediction horizon of 8 years (range 2-41), and a median of 6 predictors (range 3-24). Age, body mass index, previous injury, and occupational exposures were among the most commonly included predictors. Model discrimination after validation was generally acceptable to excellent (area under the curve = 0.70-0.85). Either internal or external validation processes were used in most models, although the risk of bias was often judged to be high with limited applicability to mass application in diverse populations. CONCLUSION Despite growing interest in multivariable prediction models for incident OA, focus remains predominantly on the knee, with reliance on data from a small pool of appropriate cohort data sets, and concerns over general population applicability.
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Affiliation(s)
| | - Martin J Thomas
- Keele University and Midlands Partnership NHS Foundation Trust, Staffordshire, and Haywood Hospital, Burslem, UK
| | - Deborah Antcliff
- Keele University, Staffordshire, Northern Care Alliance NHS Foundation Trust, Bury Care Organisation, Manchester, and University of Leeds, Leeds, UK
| | - George Peat
- Keele University, Staffordshire, and Sheffield Hallam University, Sheffield, UK
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6
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Atkins PR, Agrawal P, Mozingo JD, Uemura K, Tokunaga K, Peters CL, Elhabian SY, Whitaker RT, Anderson AE. Prediction of femoral head coverage from articulated statistical shape models of patients with developmental dysplasia of the hip. J Orthop Res 2022; 40:2113-2126. [PMID: 34812545 PMCID: PMC9124729 DOI: 10.1002/jor.25227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/04/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) is commonly described as reduced femoral head coverage due to anterolateral acetabular deficiency. Although reduced coverage is the defining trait of DDH, more subtle and localized anatomic features of the joint are also thought to contribute to symptom development and degeneration. These features are challenging to identify using conventional approaches. Herein, we assessed the morphology of the full femur and hemi-pelvis using an articulated statistical shape model (SSM). The model determined the morphological and pose-based variations associated with DDH in a population of Japanese females and established which of these variations predict coverage. Computed tomography (CT) images of 83 hips from 47 patients were segmented for input into a correspondence-based SSM. The dominant modes of variation in the model initially represented scale and pose. After removal of these factors through individual bone alignment, femoral version and neck-shaft angle, pelvic curvature, and acetabular version dominated the observed variation. Femoral head oblateness and prominence of the acetabular rim and various muscle attachment sites of the femur and hemi-pelvis were found to predict 3D CT-based coverage measurements (R2 = 0.5-0.7 for the full bones, R2 = 0.9 for the joint). Statement of Clinical Significance: Currently, clinical measurements of DDH only consider the morphology of the acetabulum. However, the results of this study demonstrated that variability in femoral head shape and several muscle attachment sites were predictive of femoral head coverage. These morphological differences may provide insight into improved clinical diagnosis and surgical planning based on functional adaptations of patients with DDH.
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Affiliation(s)
- Penny R. Atkins
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Praful Agrawal
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
| | - Joseph D. Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Japan
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | | | - Shireen Y. Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- School of Computing, University of Utah, Salt Lake City, Utah
| | - Ross T. Whitaker
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- School of Computing, University of Utah, Salt Lake City, Utah
| | - Andrew E. Anderson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
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7
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Frysz M, Faber BG, Ebsim R, Saunders FR, Lindner C, Gregory JS, Aspden RM, Harvey NC, Cootes T, Tobias JH. Machine Learning-Derived Acetabular Dysplasia and Cam Morphology Are Features of Severe Hip Osteoarthritis: Findings From UK Biobank. J Bone Miner Res 2022; 37:1720-1732. [PMID: 35811326 PMCID: PMC9545366 DOI: 10.1002/jbmr.4649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
The contribution of shape changes to hip osteoarthritis (HOA) remains unclear, as is the extent to which these vary according to HOA severity. In the present study, we used statistical shape modeling (SSM) to evaluate relationships between hip shape and HOA of different severities using UK Biobank DXA images. We performed a cross-sectional study in individuals with left hip dual-energy X-ray absorptiometry (DXA) scans. Statistical shape modeling (SSM) was used to quantify hip shape. Radiographic HOA (rHOA) was classified using osteophyte size and number and joint space narrowing. HOA outcomes ranged in severity from moderate (grade 2) to severe (grade ≥3) rHOA, hospital-diagnosed HOA, and subsequent total hip replacement (THR). Confounder-adjusted logistic regression between the top 10 hip shape modes (HSMs) and OA outcomes was performed. Further models adjusted for alpha angle (AA) and lateral center-edge angle (LCEA), reflecting acetabular dysplasia and cam morphology, respectively. Composite HSM figures were produced combining HSMs associated with separate OA outcomes. A total of 40,311 individuals were included (mean 63.7 years, 47.8% male), of whom 5.7% had grade 2 rHOA, 1.7% grade ≥3 rHOA, 1.3% hospital-diagnosed HOA, and 0.6% underwent THR. Composite HSM figures for grade 2 rHOA revealed femoral neck widening, increased acetabular coverage, and enlarged lesser and greater trochanters. In contrast, grade ≥3 rHOA, hospital-diagnosed HOA, and THR were suggestive of cam morphology and reduced acetabular coverage. Associations between HSMs depicting cam morphology and reduced acetabular coverage and more severe HOA were attenuated by AA and LCEA adjustment, respectively. Relationships between hip shape and HOA differed according to severity. Notably, cam morphology and acetabular dysplasia were features of severe HOA, but unrelated to moderate disease, suggesting possible prognostic utility. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Monika Frysz
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Benjamin G Faber
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data SciencesThe University of ManchesterManchesterUK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenAberdeenUK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data SciencesThe University of ManchesterManchesterUK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenAberdeenUK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenAberdeenUK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospitals Southampton NHS Foundation TrustSouthamptonUK
| | - Tim Cootes
- Division of Informatics, Imaging and Data SciencesThe University of ManchesterManchesterUK
| | - Jon H Tobias
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
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8
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Scorcelletti M, Kara S, Zange J, Jordan J, Semler O, Schönau E, Rittweger J, Ireland A, Seefried L. Lower limb bone geometry in adult individuals with X-linked hypophosphatemia: an observational study. Osteoporos Int 2022; 33:1601-1611. [PMID: 35435480 PMCID: PMC9187561 DOI: 10.1007/s00198-022-06385-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/25/2022] [Indexed: 12/05/2022]
Abstract
UNLABELLED We assessed lower-limb geometry in adults with X-linked hypophosphatemia (XLH) and controls. We found large differences in multiple measures including femoral and tibial torsion, bowing and cross-sectional area and acetabular version and coverage which may contribute to clinical problems such as osteoarthritis, fractures and altered gait common in XLH. PURPOSE Individuals with X-linked hypophosphatemia (XLH) are at risk of lower-limb deformities and early onset of osteoarthritis. These two factors may be linked, as altered biomechanics is a risk factor for osteoarthritis. This exploratory evaluation aims at providing clues and concepts for this association to facilitate future larger-scale and longitudinal studies on that aspect. METHODS For this observational study, 13 patients with XLH, aged 18-65 years (6 female), were compared with sex-, age- and weight-matched healthy individuals at a single German research centre. Femoral and hip joint geometry, including femoral and tibial torsion and femoral and tibial shaft bowing, bone cross-sectional area (CSA) and acetabular version and coverage were measured from magnetic resonance imaging (MRI) scans. RESULTS Total femoral torsion was 29° lower in individuals with XLH than in controls (p < 0.001), mainly resulting from lower intertrochanteric torsion (ITT) (p < 0.001). Femoral lateral and frontal bowing, tibial frontal bowing, mechanical axis, femoral mechanical-anatomical angle, acetabular version and acetabular coverage were all greater and tibial torsion lower in individuals with XLH as compared to controls (all p < 0.05). Greater femoral total and marrow cavity CSA, greater tibial marrow cavity CSA and lower cortical CSA were observed in XLH (all p < 0.05). DISCUSSION We observed large differences in clinically relevant measures of tibia and particularly femur bone geometry in individuals with XLH compared to controls. These differences may plausibly contribute to clinical manifestations of XLH such as early-onset osteoarthritis, pseudofractures and altered gait and therefore should be considered when planning corrective surgeries.
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Affiliation(s)
- Matteo Scorcelletti
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Serhan Kara
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
| | - Jochen Zange
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
| | - Jens Jordan
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Eckhard Schönau
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Jörn Rittweger
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Alex Ireland
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Lothar Seefried
- Orthopaedic Department, University of Würzburg, Wurzburg, Germany.
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Natürlicher Verlauf, konservative Behandlungsmethoden und optimaler Operationszeitpunkt der symptomatischen Hüftgelenkdysplasie. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-021-00504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Casartelli NC, Maffiuletti NA, Valenzuela PL, Grassi A, Ferrari E, van Buuren MMA, Nevitt MC, Leunig M, Agricola R. Is hip morphology a risk factor for developing hip osteoarthritis? A systematic review with meta-analysis. Osteoarthritis Cartilage 2021; 29:1252-1264. [PMID: 34171473 DOI: 10.1016/j.joca.2021.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/27/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To appraise the highest evidence on hip morphology as a risk factor for developing hip osteoarthritis (OA). DESIGN We searched for studies evaluating the association between radiological hip morphology parameters and the prevalence, incidence or progression of hip OA (based on different radiographic and clinical criteria) in the MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library and PEDro databases from inception until June 2020. Prospective and cross-sectional studies were separately evaluated. Data are presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS We included 9 prospective and 21 cross-sectional studies in the meta-analysis, and evaluated 42,831 hips from 25,898 individuals (mean age: 59 years). Prospective studies showed that, compared with control hips, hips with cam morphology (alpha angle >60°; OR = 2.52, 95% CI: 1.83 to 3.46, P < 0.001) or hip dysplasia (lateral center-edge angle (LCEA) <25°; OR = 2.38, 95% CI: 1.84 to 3.07, P < 0.001), but not hips with pincer morphology (LCEA >39°; OR = 1.08, 95% CI: 0.57 to 2.07, P = 0.810), were more likely to develop hip OA than hips without these morphologies. Cross-sectional studies showed a greater prevalence of pincer morphology (LCEA >39°, OR = 3.71, 95% CI: 2.98 to 4.61, P < 0.001) and acetabular retroversion (crossover sign; OR = 2.65, 95% CI: 1.17 to 6.03, P = 0.020) in hips with OA than in control hips. CONCLUSION Cam morphology and hip dysplasia were consistently associated with the development of hip OA. Pincer morphology was associated with hip OA in cross-sectional but not in prospective studies. The heterogeneous quantification of pincer morphology on radiographs limits a clear conclusion on its association with hip OA.
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Affiliation(s)
- N C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland; Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - N A Maffiuletti
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.
| | - P L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - A Grassi
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | - E Ferrari
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - M M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - M Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
| | - R Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Wilkinson JM, Zeggini E. The Genetic Epidemiology of Joint Shape and the Development of Osteoarthritis. Calcif Tissue Int 2021; 109:257-276. [PMID: 32393986 PMCID: PMC8403114 DOI: 10.1007/s00223-020-00702-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023]
Abstract
Congruent, low-friction relative movement between the articulating elements of a synovial joint is an essential pre-requisite for sustained, efficient, function. Where disorders of joint formation or maintenance exist, mechanical overloading and osteoarthritis (OA) follow. The heritable component of OA accounts for ~ 50% of susceptible risk. Although almost 100 genetic risk loci for OA have now been identified, and the epidemiological relationship between joint development, joint shape and osteoarthritis is well established, we still have only a limited understanding of the contribution that genetic variation makes to joint shape and how this modulates OA risk. In this article, a brief overview of synovial joint development and its genetic regulation is followed by a review of current knowledge on the genetic epidemiology of established joint shape disorders and common shape variation. A summary of current genetic epidemiology of OA is also given, together with current evidence on the genetic overlap between shape variation and OA. Finally, the established genetic risk loci for both joint shape and osteoarthritis are discussed.
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Affiliation(s)
- J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
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12
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The Management between Comorbidities and Pain Level with Physical Activity in Individuals with Hip Osteoarthritis with Surgical Indication: A Cross-Sectional Study. ACTA ACUST UNITED AC 2021; 57:medicina57090890. [PMID: 34577813 PMCID: PMC8470884 DOI: 10.3390/medicina57090890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: The degenerative pathology of the hip joint appears in young age groups, related to fem-oroacetabular impingement, and in advanced age, due to other inflammatory causes, with greater potential for severity in the presence of comorbidities. Objectives: To evaluate the participation of the main causes of osteoarthritis in relation to physical activities, s Body Mass Index (BMI) and television time (TV). Materials and Methods: 54 patients with surgical indication treated at an orthopedic referral university hospital were stratified into groups (Impact: I, Osteonecrosis/rheumatic: II, Infectious/traumatic: III), and the influence of comorbidities on physical activity performance, relative to BMI and TV time. Results: It was observed that the impact group was the most frequent (51.8%), with 79.6% under the age of 60 years. This group followed the general mean (p < 0.05), using the variables of comorbidity and the level of physical activity. Pain intensity, TV time, BMI showed no correlation with physical activity. Conclusion: Morphostructural changes (group I) represented the most frequent etiological group, and severe pain was common in almost the entire sample. Unlike BMI, comorbidity showed a significant relationship with the level of physical activity.
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13
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van Buuren MMA, Arden NK, Bierma-Zeinstra SMA, Bramer WM, Casartelli NC, Felson DT, Jones G, Lane NE, Lindner C, Maffiuletti NA, van Meurs JBJ, Nelson AE, Nevitt MC, Valenzuela PL, Verhaar JAN, Weinans H, Agricola R. Statistical shape modeling of the hip and the association with hip osteoarthritis: a systematic review. Osteoarthritis Cartilage 2021; 29:607-618. [PMID: 33338641 DOI: 10.1016/j.joca.2020.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/30/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis. DESIGN We conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting original data on the longitudinal relationship between radiographic hip shape (quantified by SSM) and hip OA were eligible. Quantitative meta-analysis was precluded because of the use of different SSM models across studies. We used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. RESULTS Nine studies (6,483 hips analyzed with SSM) were included in this review. The SSM models used to describe hip shape ranged from 16 points on the femoral head to 85 points on the proximal femur and hemipelvis. Multiple hip shape features and combinations thereof were associated with incident or progressive hip OA. Shape variants that seemed to be consistently associated with hip OA across studies were acetabular dysplasia, cam morphology, and deviations in acetabular version (either excessive anteversion or retroversion). CONCLUSIONS Various radiographic, SSM-defined hip shape features are associated with hip OA. Some hip shape features only seem to increase the risk for hip OA when combined together. The heterogeneity of the used SSM models across studies precludes the estimation of pooled effect sizes. Further studies using the same SSM model and definition of hip OA are needed to allow for the comparison of outcomes across studies, and to validate the found associations.
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Affiliation(s)
- M M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - N K Arden
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; NIHR Musculoskeletal Biomedical Research Unit, Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, University of Oxford, Oxford, UK
| | - S M A Bierma-Zeinstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice and Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N C Casartelli
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland; Laboratory of Exercise and Health, ETH Zürich, Schwerzenbach, Switzerland
| | - D T Felson
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - N E Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - C Lindner
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - N A Maffiuletti
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - J B J van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A E Nelson
- Thurston Arthritis Research Center and Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - P L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - J A N Verhaar
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - R Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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14
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Frysz M, Baird D, Gregory JS, Aspden RM, Lane NE, Ohlsson C, Pettersson-Kymmer U, Karasik D, Tobias JH, Paternoster L. The influence of adult hip shape genetic variants on adolescent hip shape: Findings from a population-based DXA study. Bone 2021; 143:115792. [PMID: 33285254 PMCID: PMC7809624 DOI: 10.1016/j.bone.2020.115792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/06/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Hip shape is a well-recognized risk factor for hip osteoarthritis (OA) and hip fracture. We aimed to investigate whether the genetic variants known to be associated with adult hip shape were also associated with adolescent hip shape. METHODS Hip DXA scans, obtained in offspring from the Avon Longitudinal Study of Parents and Children (ALSPAC) at two time points (mean ages 13.8 and 17.8 years), were used to quantify hip morphology using a 53-point Statistical Shape Model (SSM). Principal component analysis was used to generate hip shape modes (HSMs). Genetic variants which had previously shown genome-wide significant association with specific HSMs in adults were tested for association with the same HSMs in adolescents (at each timepoint separately) using SNPTEST v2. RESULTS Complete genotypic and phenotypic data were available for 3550 and 3175 individuals at 14 and 18 years, respectively. The strongest evidence for association with adolescent hip shape was for a variant located near SOX9 (rs2158915) with consistent effects across both time points for HSM1 (age 14: beta -0.05, p = 9.9 × 10-8; age 18: -0.05, p = 3.3 × 10-6) and HSM5 (age 14: beta -0.07, p = 1.6 × 10-4; age 18: -0.1, p = 2.7 × 10-6). There was also strong evidence of association between rs10743612 (near PTHLH) and HSM1 (age 14: 0.05, p = 1.1 × 10-5; age 18: 0.04, p = 0.003) and between rs6537291 (near HHIP) and HSM2 (age 14: -0.06, p = 0.001; age 18: -0.07, p = 0.001) across both time points. The genes with the strongest associations with hip shape in adolescents, (SOX9, PTHLH and HHIP) are known to be involved in endochondral bone formation. HSM1 indicates narrower aspect ratio of the upper femur, whereas both HSM2 and HSM5 reflect variation in the femoral head size and femoral neck width, features previously found to be related to the risk of OA in later life. The SOX9 locus has previously been found to associate with increased risk of hip fracture. CONCLUSION In conclusion, variants implicated in endochondral bone formation appear to consistently influence hip shape between adolescence and adulthood, including those aspects related to risk of hip OA and/or fracture in later life.
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Affiliation(s)
- Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Denis Baird
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jenny S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Claes Ohlsson
- Centre of Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | | | - David Karasik
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lavinia Paternoster
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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15
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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.
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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
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16
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Frysz M, Gregory JS, Aspden RM, Paternoster L, Tobias JH. The effect of pubertal timing, as reflected by height tempo, on proximal femur shape: Findings from a population-based study in adolescents. Bone 2020; 131:115179. [PMID: 31794847 PMCID: PMC6961111 DOI: 10.1016/j.bone.2019.115179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the relationship between pubertal timing (using measures of height tempo) and proximal femur shape in a large adolescent cohort. METHODS Hip DXA scans were obtained in offspring from the Avon Longitudinal Study of Parents and Children. To quantify hip morphology, the images were analyzed using Shape software based on a 53-point statistical shape model and independent modes of variation (hip shape mode (HSM) scores) for each image were generated. Height tempo (which corresponds to age at peak height velocity (aPHV)) was estimated from serial height measurements collected between age 5-20 years. Multivariable linear regression was used to examine cross-sectional associations between height tempo and the top ten HSMs at age 14 and 18, adjusting for sex and fat mass index (FMI). RESULTS Complete outcome and covariate data were available from 3827 and 3507 participants at age 14 and 18 years, respectively. Mean aPHV was 13.5 and 11.8 years for males and females, respectively. At age 14, height tempo was associated with a majority of modes, except for HSM4 and there was strong evidence of interaction by sex. In males, all modes showed evidence of an association with tempo, independent of FMI, with the strongest observed for HSM8 (adjusted β 0.38 (0.33, 0.43) p = 4.1 × 10-50). Compared with males, the associations were generally weaker in females, with the strongest effect observed for HSM8 (adjusted β 0.10 (0.05, 0.14) p = 1.6 × 10-5). The overall effect of later pubertal timing on proximal femur shape in males was a narrower femoral neck and larger superolateral head, whereas in females these changes were hard to discern. When assessed at age 18, there was little relationship between tempo and proximal femur shape in either sex. CONCLUSION Our results indicate that significant changes in hip shape occur during puberty, including aspects of shape which may be related to future risk of hip OA and/or fracture. However, puberty timing per se does not appear to exert long lasting effects on proximal femur shape.
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Affiliation(s)
- Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Lavinia Paternoster
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
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17
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Shapira J, Chen JW, Bheem R, Lall AC, Rosinsky PJ, Maldonado DR, Domb BG. Radiographic factors associated with hip osteoarthritis: a systematic review. J Hip Preserv Surg 2020; 7:4-13. [PMID: 32382423 PMCID: PMC7195936 DOI: 10.1093/jhps/hnz073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study was to outline factors that contribute to the appearance of hip osteoarthritis (OA). Secondarily, this study aims to describe radiographic factors that are associated with the progression of OA in the arthritic hip. Pubmed/MEDLINE and Embase were searched in November 2018 for radiographic risk factors for hip OA. All articles were eligible if they (i) were written in the English language and (ii) commented on OA as it relates to radiographic description, appearance or progression of OA. Demographic characteristics of the study cohort, definition of OA, baseline OA and factors for prediction or progression of OA were recorded. Nine articles were included in this review. A total of 3268 patients were analyzed across all studies. The mean age was 60.0 years (range 18-91.5). The most common descriptors for OA were dysplasia and cam impingement. Six of the nine articles found acetabular under-coverage to be associated with developing OA. Four articles found cam morphology to be an associated factor. Finally, four articles commented on the factors associated with the progression to more severe grades of OA, reporting exclusively on acetabular under-coverage, whereas only one reported on cam morphology to be associated. This systematic review found acetabular under-coverage followed by cam morphology to be strongly associated with both the development and progression of hip OA. These findings define patients at risk for developing hip OA and emphasize the importance of early awareness of future joint degeneration.
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Affiliation(s)
- Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines, IL, USA
| | - Jeffrey W Chen
- American Hip Institute Research Foundation, Des Plaines, IL, USA
| | - Rishika Bheem
- American Hip Institute Research Foundation, Des Plaines, IL, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Des Plaines, IL, USA
- American Hip Institute, 999 E Touhy Ave, Suite 450, Des Plaines, IL 60018, USA
| | | | | | - Benjamin G Domb
- American Hip Institute Research Foundation, Des Plaines, IL, USA
- American Hip Institute, 999 E Touhy Ave, Suite 450, Des Plaines, IL 60018, USA
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18
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Gielis WP, Weinans H, Welsing PMJ, van Spil WE, Agricola R, Cootes TF, de Jong PA, Lindner C. An automated workflow based on hip shape improves personalized risk prediction for hip osteoarthritis in the CHECK study. Osteoarthritis Cartilage 2020; 28:62-70. [PMID: 31604136 DOI: 10.1016/j.joca.2019.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/07/2019] [Accepted: 09/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To design an automated workflow for hip radiographs focused on joint shape and tests its prognostic value for future hip osteoarthritis. DESIGN We used baseline and 8-year follow-up data from 1,002 participants of the CHECK-study. The primary outcome was definite radiographic hip osteoarthritis (rHOA) (Kellgren-Lawrence grade ≥2 or joint replacement) at 8-year follow-up. We designed a method to automatically segment the hip joint from radiographs. Subsequently, we applied machine learning algorithms (elastic net with automated parameter optimization) to provide the Shape-Score, a single value describing the risk for future rHOA based solely on joint shape. We built and internally validated prediction models using baseline demographics, physical examination, and radiologists scores and tested the added prognostic value of the Shape-Score using Area-Under-the-Curve (AUC). Missing data was imputed by multiple imputation by chained equations. Only hips with pain in the corresponding leg were included. RESULTS 84% were female, mean age was 56 (±5.1) years, mean BMI 26.3 (±4.2). Of 1,044 hips with pain at baseline and complete follow-up, 143 showed radiographic osteoarthritis and 42 were replaced. 91.5% of the hips had follow-up data available. The Shape-Score was a significant predictor of rHOA (odds ratio per decimal increase 5.21, 95%-CI (3.74-7.24)). The prediction model using demographics, physical examination, and radiologists scores demonstrated an AUC of 0.795, 95%-CI (0.757-0.834). After addition of the Shape-Score the AUC rose to 0.864, 95%-CI (0.833-0.895). CONCLUSIONS Our Shape-Score, automatically derived from radiographs using a novel machine learning workflow, may strongly improve risk prediction in hip osteoarthritis.
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Affiliation(s)
- W P Gielis
- UMC Utrecht, Department of Orthopedics and Department of Radiology, Utrecht, the Netherlands.
| | - H Weinans
- UMC Utrecht, Department of Orthopedics and Department of Rheumatology & Clinical Immunology, Utrecht, the Netherlands; TU Delft, Department of Biomechanical Engineering, Delft, the Netherlands.
| | - P M J Welsing
- UMC Utrecht, Department of Rheumatology & Clinical Immunology, Utrecht, the Netherlands.
| | - W E van Spil
- UMC Utrecht, Department of Rheumatology & Clinical Immunology, Utrecht, the Netherlands.
| | - R Agricola
- Erasmus MC, Department of Orthopedics, Rotterdam, the Netherlands.
| | - T F Cootes
- University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom.
| | - P A de Jong
- UMC Utrecht, Department of Radiology, Utrecht, the Netherlands.
| | - C Lindner
- University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom.
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19
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Tran DH, Hoshino H, Togawa D, Matsuyama Y. Characteristics of radiographic morphometries of the lower leg in subjects with progression of knee osteoarthritis in the TOEI cohort. Aging Clin Exp Res 2020; 32:67-76. [PMID: 30840205 DOI: 10.1007/s40520-019-01164-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Knee osteoarthritis is one of the most common orthopedic diseases. However, few studies have reported the morphometric characteristics of the lower leg related to the progression of knee osteoarthritis in regional populations. This study aimed to determine the radiographic morphometries of the lower leg in subjects who showed progression of osteoarthritis of the knee in the TOEI cohort. METHODS Data were collected from the TOEI study cohort, during the period from 2014 to 2016, to assess osteoarthritis of the knee and radiographic morphometries of the lower leg. The joints were divided into three groups according to osteoarthritis progression over 2 years. There were 323 legs of females and 163 legs of males. Knees which did not exhibit osteoarthritis were in group 1; knees with osteoarthritis that remained stable for 2 years were in group 2; knees that worsened osteoarthritis over 2 years were in group 3. Morphometric parameters in the lower leg were measured by radiographs taken in 2014. RESULTS In female subjects, group 2 had higher age, lower lever arm ratio and lower hip-knee-ankle angle, and higher height of the hip center compared with group (1). Group 3 had higher age compared with group 1 and lower height of the hip center compared with group (2). In male subjects, group 2 had lower height of the hip center and lower hip-knee-ankle angle compared with group 1. Group 3 had higher patellar shift index compared with group 1, higher height of the hip center and higher femoral neck length compared with group 2. CONCLUSIONS Higher age was the risk of osteoarthritis progression of the knee in female subjects but not significant risk in male subjects. Hip morphometries such as height of the hip center and femoral neck length in which showed a sex difference might be associated with the progression of knee osteoarthritis.
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Affiliation(s)
- Dung Huu Tran
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Hironobu Hoshino
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Daisuke Togawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
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Unpicking observational relationships between hip shape and osteoarthritis: hype or hope? Curr Opin Rheumatol 2019; 32:110-118. [PMID: 31644466 DOI: 10.1097/bor.0000000000000673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To review recent findings concerning the observational relationship between hip shape and hip osteoarthritis (HOA) and their shared genetic influences, and the potential for clinical application. RECENT FINDINGS Recent observational studies have strengthened the evidence that specific shape deformities, such as cam and acetabular dysplasia, are related to HOA. Statistical shape modelling has emerged as a method to measure hip shape holistically, with the added advantage that this can be applied to dual X-ray absorptiometry scan images. This has led to several additional aspects of hip shape variation being identified, such as a wider femoral neck and larger lesser trochanter, in association with HOA. Furthermore, this method has formed the basis of genetic studies identifying novel genetic influences on hip shape, several of which are shared with known genetic risk factors for HOA. SUMMARY Shared genetic influences of hip shape and HOA raise the possibility that hip shape plays a casual role in the development of HOA, justifying preventive approaches aiming to combat these adverse consequences.
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Günther KP, Goronzy J, Franken L, Hartmann A, Thielemann F. Natürlicher Verlauf bei Hüftdysplasie und Operationsergebnisse. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-018-0232-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Purpose of review This narrative review summarizes the evidence relating hip shape and risk of osteoarthritis at the hip, with a focus on the most recent body of work. Recent findings Hip OA is a prevalent and potentially disabling condition with few effective non-surgical treatment options. Risk factors for hip OA appear to differ somewhat from those at other sites. Variations in hip morphology, whether assessed through standard geometric measures or statistical modeling methods, seem to increase hip OA risk and may provide a novel approach to interventions to reduce or prevent OA. Such variations have also led to focused surgical interventions to "correct" abnormal shape, although comparisons with non-surgical management are lacking. Summary There remains a lack of understanding regarding the optimal management, whether surgical, non-surgical, or a combination, for FAI syndrome. Even less is known regarding other potential morphologic variations that may contribute to OA risk. Additionally, many individuals who have shape variations that would seem to increase their risk will never develop hip OA. Questions remain regarding key risk factors for hip OA development, which individuals should be targeted for therapies, whether directed at symptoms, function, or prevention, and which therapies should be studied and offered. Trials are underway to help address some of these questions.
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Leslie WD, Lix LM, Majumdar SR, Morin SN, Johansson H, Odén A, McCloskey EV, Kanis JA. Total Hip Bone Area Affects Fracture Prediction With FRAX® in Canadian White Women. J Clin Endocrinol Metab 2017; 102:4242-4249. [PMID: 29092086 DOI: 10.1210/jc.2017-01327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/11/2017] [Indexed: 01/17/2023]
Abstract
CONTEXT Areal bone mineral density (BMD) measurements are confounded by skeletal size. Hip BMD is an input to the FRAX® tool (Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom), but it is unknown whether performance is affected by hip area. OBJECTIVE To examine whether fracture prediction by FRAX® is affected by hip area. DESIGN AND SETTING Cohort study using a population-based BMD registry. PATIENTS A total of 58,108 white women aged ≥40 years. MAIN OUTCOME MEASURES Incident major osteoporotic fracture (MOF; n = 4913) and hip fracture (n = 1369), stratified by total hip area quintile, before and after adjustment for hip axis length (HAL). RESULTS Smaller hip area was associated with younger age and lower FRAX® scores, whereas incident fractures were greater in those with larger hip area (P for trend < 0.001). Larger hip area quintile increased risk for MOF and hip fracture when adjusted for FRAX® score with BMD (P for trend < 0.001). Each standard deviation increase in hip area was associated with greater risk for incident MOF [adjusted hazard ratio (HR), 1.08; 95% confidence interval (CI), 1.05 to 1.11] and hip fracture (HR, 1.16; 95% CI, 1.11 to 1.21), but not after adjustment for HAL. FRAX® with BMD underestimated MOF risk in the largest hip area quintile and underestimated hip fracture risk in the three largest hip area quintiles. CONCLUSIONS In Canadian white women, skeletal size based on hip area affects fracture risk assessment based on FRAX® score with BMD, with risk underestimated in those with larger hip areas. Including HAL in the risk assessment compensates for this confounding by skeletal size and provides for more accurate assessment of fracture risk.
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Affiliation(s)
- William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Lisa M Lix
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Victoria 3000, Australia
| | - Anders Odén
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Victoria 3000, Australia
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Edmondson CP, Schwartz EN. Non-BMD DXA measurements of the hip. Bone 2017; 104:73-83. [PMID: 28476576 DOI: 10.1016/j.bone.2017.03.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/19/2017] [Accepted: 03/19/2017] [Indexed: 12/31/2022]
Abstract
Hip fracture is one of the most serious complications of osteoporosis. More than 50% of hip and other fractures occur in patients without densitometric osteoporosis. Therefore, areal bone mineral density (aBMD) may not be the best way to assess fracture risk. In order to improve assessment of fracture risk, many other approaches have been taken. At the present time, the Fracture Risk Algorithm (FRAX©) is one of the most notable ways to improve assessment of fracture risk. However, since early in the initiation of the dual energy x-ray absorptiometry (DXA) era, several non-BMD DXA approaches to the assessment of hip fracture risk have been proposed. This review will cover some of those methodologies, including hip-axis length (HAL), hip-structural analysis (HSA), finite element analysis (FEA) by DXA, and body composition of the thigh by DXA (BCT). These methods have been utilized in models of hip fracture occurrence and in pharmacological clinical trials. How they should be used in clinical practice or if they should be used in clinical practice is more of an issue. In addition, we will discuss the recent proposal of the use of Long Femur Scan Field in the effort to diagnose atypical femoral fractures.
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Affiliation(s)
- Clinten P Edmondson
- The Northern California Institute for Bone Health, Inc., Orinda, CA 94563, United States.
| | - Elliott N Schwartz
- The Northern California Institute for Bone Health, Inc., Orinda, CA 94563, United States.
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Mosler AB, Crossley KM, Waarsing JH, Jomaah N, Weir A, Hölmich P, Agricola R. Ethnic Differences in Bony Hip Morphology in a Cohort of 445 Professional Male Soccer Players. Am J Sports Med 2016; 44:2967-2974. [PMID: 27492971 DOI: 10.1177/0363546516656163] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Participation in high-impact athletic activities has recently been associated with a higher prevalence of cam deformity. Bony hip morphology has also emerged as an important factor in the development of hip osteoarthritis. However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high-impact sports. PURPOSE To investigate whether the prevalence of specific bony hip morphological abnormalities differed between professional male soccer players of diverse ethnic backgrounds. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Professional male soccer players from an entire league attending preparticipation screening were invited to participate in this study. Ethnicity was registered, and standardized radiographs of anteroposterior pelvic and Dunn views were obtained. Cam and pincer deformity, and acetabular dysplasia were quantified using the alpha angle, triangular index, and lateral center-edge angle (LCEA). Regression analyses with generalized estimating equations were used to determine prevalence differences in bony hip morphology. RESULTS A total of 445 male soccer players (890 hips; mean age ± SD, 25 ± 4.9 years) participated in the study, representing the following ethnic groups: Arabic (59%), black (24%), Persian (7%), white (6%), East Asian (2%), and other (2%). The prevalence of cam deformity (alpha angle >60°) ranged from 57.5% to 71.7% across 4 of the groups, but East Asians had a significantly lower prevalence (18.8%; P ≤ .032). A large cam deformity (alpha angle >78°) was more prevalent in white (33.3%) compared with black soccer players (17.8%; P = .041) and was absent in East Asian players. Pincer deformity (LCEA >40°) was uncommon (3%) in all ethnicities. The prevalence of acetabular dysplasia (LCEA <20°) ranged from 8.0% to 16.7%, apart from the white group, in which prevalence was only 1.9% (P = .03). CONCLUSION The prevalence of a cam deformity and acetabular dysplasia differed between ethnicities in this cohort of professional male soccer players. These findings suggest that there may be ethnic differences in both acetabular morphology and femoral bony response to athletic load.
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Affiliation(s)
- Andrea B Mosler
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar .,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kay M Crossley
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jan H Waarsing
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Nabil Jomaah
- Radiology Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Per Hölmich
- Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopedic Research Center-Copenhagen, Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Rintje Agricola
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Differential effects of altered patterns of movement and strain on joint cell behaviour and skeletal morphogenesis. Osteoarthritis Cartilage 2016; 24:1940-1950. [PMID: 27374878 PMCID: PMC5081689 DOI: 10.1016/j.joca.2016.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/10/2016] [Accepted: 06/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE There is increasing evidence that joint shape is a potent predictor of osteoarthritis (OA) risk; yet the cellular events underpinning joint morphogenesis remain unclear. We sought to develop a genetically tractable animal model to study the events controlling joint morphogenesis. DESIGN Zebrafish larvae were subjected to periods of flaccid paralysis, rigid paralysis or hyperactivity. Immunohistochemistry and transgenic reporters were used to monitor changes to muscle and cartilage. Finite Element Models were generated to investigate the mechanical conditions of rigid paralysis. Principal component analysis was used to test variations in skeletal morphology and metrics for shape, orientation and size were applied to describe cell behaviour. RESULTS We show that flaccid and rigid paralysis and hypermobility affect cartilage element and joint shape. We describe differences between flaccid and rigid paralysis in regions showing high principal strain upon muscle contraction. We identify that altered shape and high strain occur in regions of cell differentiation and we show statistically significant changes to cell maturity occur in these regions in paralysed and hypermobile zebrafish. CONCLUSION While flaccid and rigid paralysis and hypermobility affect skeletal morphogenesis they do so in subtly different ways. We show that some cartilage regions are unaffected in conditions such as rigid paralysis where static force is applied, whereas joint morphogenesis is perturbed by both flaccid and rigid paralysis; suggesting that joints require dynamic movement for accurate morphogenesis. A better understanding of how biomechanics impacts skeletal cell behaviour will improve our understanding of how foetal mechanics shape the developing joint.
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Jackson KA, Glyn-Jones S, Batt ME, Arden NK, Newton JL. Assessing risk factors for early hip osteoarthritis in activity-related hip pain: a Delphi study. BMJ Open 2015; 5:e007609. [PMID: 26419679 PMCID: PMC4593156 DOI: 10.1136/bmjopen-2015-007609] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Hip pain and injury as a result of activity can lead to the development of early hip osteoarthritis (OA) in susceptible individuals. Our understanding of the factors that increase susceptibility continues to evolve. The ability to clearly identify individuals (and cohorts) with activity-related hip pain who are at risk of early hip OA is currently lacking. The purpose of this study was to gain expert consensus on which key clinical measures might help predict the risk of early hip OA in individuals presenting with activity-related hip pain. The agreed measures would constitute a standardised approach to initial clinical assessment to help identify these individuals. METHODS This Dephi study used online surveys to gain concordance of expert opinion in a structured process of 'rounds'. In this study, we asked 'What outcome measures are useful in predicting hip OA in activity-related hip pain?' The Delphi panel consisted of experts from sport and exercise medicine, orthopaedics, rheumatology, physiotherapy and OA research. RESULTS The study identified key clinical measures in the history, examination and investigations (plain anteroposterior radiograph and femoroacetabular impingement views) that the panel agreed would be useful in predicting future risk of hip OA when assessing activity-related hip pain. The panel also agreed that certain investigations and tests (eg, MR angiography) did not currently have a role in routine assessment. There was a lack of consensus regarding the role of MRI, patient-reported outcome measures (PROMs) and certain biomechanical and functional assessments. CONCLUSIONS We provide a standardised approach to the clinical assessment of patients with activity-related hip pain. Assessment measures rejected by the Delphi panel were newer, more expensive investigations that currently lack evidence. Assessment measures that did not reach consensus include MRI and PROMs. Their role remains ambiguous and would benefit from further research.
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Affiliation(s)
- K A Jackson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
| | - S Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
| | - M E Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queen's Medical Centre, Nottingham, UK
| | - N K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
| | - J L Newton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
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Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over 1200 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Agricola R, Leyland KM, Bierma-Zeinstra SMA, Thomas GE, Emans PJ, Spector TD, Weinans H, Waarsing JH, Arden NK. Validation of statistical shape modelling to predict hip osteoarthritis in females: data from two prospective cohort studies (Cohort Hip and Cohort Knee and Chingford). Rheumatology (Oxford) 2015; 54:2033-41. [PMID: 26139655 DOI: 10.1093/rheumatology/kev232] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To prospectively investigate whether hip shape variants at baseline are associated with the need for future total hip replacement (THR) in women and to validate the resulting associated shape variants of the Cohort Hip and Cohort Knee (CHECK) cohort and the Chingford cohort. METHODS Female participants from the CHECK cohort without radiographic OA (Kellgren-Lawrence score <2) at baseline were included (1100 hips); 22 hips had a THR within 5 years of follow-up. For the Chingford cohort, with only female participants, hips without radiographic OA at baseline were selected and a nested case-control design was used, with 19 THR cases within 19 years of follow-up and 95 controls matched 5 to 1 for age and BMI. Hip shape on baseline anteroposterior pelvic radiographs was assessed by statistical shape modelling (SSM) using the same model for both cohorts. RESULTS In the CHECK and Chingford cohorts, the respective mean age was 55.8 (s.d. 5.1) and 53.6 (s.d. 5.4) and the BMI was 26.14 (s.d. 4.3) and 25.7 (s.d. 3.3), respectively. Multiple shape variants of the hip were significantly (P < 0.05) associated with future THR in both the CHECK (modes 4, 11, 15, 17 and 22) and Chingford (modes 2 and 17) cohorts. Mode 17 [odds ratio (OR) 0.51 (95% CI 0.33, 0.80) in the CHECK cohort], representing a flattened head-neck junction and flat greater trochanter, could be confirmed in the Chingford cohort [OR 0.41 (95% CI 0.23, 0.82)]. Modes 4 and 15 of the CHECK cohort also showed non-significant trends in the Chingford cohort. CONCLUSION Several baseline shape variants are associated with the future need for THR within a cohort. Despite differences in participant characteristics, radiographic protocol and follow-up time, we could validate at least one shape variant, suggesting that SSM is reasonably transferable between cohorts.
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Affiliation(s)
- Rintje Agricola
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands, Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis,
| | - Kirsten M Leyland
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands, Department of General Practice, Erasmus University Medical Centre, Rotterdam
| | - Geraint E Thomas
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pieter J Emans
- Department of Orthopaedics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King's College, London, UK
| | - Harrie Weinans
- Department of Orthopaedics and Department of Rheumatology, University Medical Centre Utrecht, Utrecht and Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jan H Waarsing
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nigel K Arden
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Bassett JHD, Boyde A, Zikmund T, Evans H, Croucher PI, Zhu X, Park JW, Cheng SY, Williams GR. Thyroid hormone receptor α mutation causes a severe and thyroxine-resistant skeletal dysplasia in female mice. Endocrinology 2014; 155:3699-712. [PMID: 24914936 PMCID: PMC4138578 DOI: 10.1210/en.2013-2156] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/11/2014] [Indexed: 02/03/2023]
Abstract
A new genetic disorder has been identified that results from mutation of THRA, encoding thyroid hormone receptor α1 (TRα1). Affected children have a high serum T3:T4 ratio and variable degrees of intellectual deficit and constipation but exhibit a consistently severe skeletal dysplasia. In an attempt to improve developmental delay and alleviate symptoms of hypothyroidism, patients are receiving varying doses and durations of T4 treatment, but responses have been inconsistent so far. Thra1(PV/+) mice express a similar potent dominant-negative mutant TRα1 to affected individuals, and thus represent an excellent disease model. We hypothesized that Thra1(PV/+) mice could be used to predict the skeletal outcome of human THRA mutations and determine whether prolonged treatment with a supraphysiological dose of T4 ameliorates the skeletal abnormalities. Adult female Thra1(PV/+) mice had short stature, grossly abnormal bone morphology but normal bone strength despite high bone mass. Although T4 treatment suppressed TSH secretion, it had no effect on skeletal maturation, linear growth, or bone mineralization, thus demonstrating profound tissue resistance to thyroid hormone. Despite this, prolonged T4 treatment abnormally increased bone stiffness and strength, suggesting the potential for detrimental consequences in the long term. Our studies establish that TRα1 has an essential role in the developing and adult skeleton and predict that patients with different THRA mutations will display variable responses to T4 treatment, which depend on the severity of the causative mutation.
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Affiliation(s)
- J H Duncan Bassett
- Department of Medicine (J.H.D.B., G.R.W.), Imperial College London, London W12 0NN, United Kingdom; Dental Physical Sciences, Oral Growth and Development (A.B.), Queen Mary University of London, London E1 4NS, United Kingdom; Laboratory of X-Ray Micro-Computed Tomography and Nano-Computed Tomography (T.Z.), Central European Institute of Technology, Brno University of Technology CZ-61600 Brno, Czech Republic; Sheffield Myeloma Research Team (H.E.), University of Sheffield, Sheffield S10 2RX, United Kingdom; Bone Biology Program (P.I.C.), Garvan Institute of Medical Research, Sydney NSW 2010, Australia; and Laboratory of Molecular Biology (X.Z., J.W.P., S-y.C.), National Cancer Institute, Bethesda, Maryland 20892
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Hofman A, Darwish Murad S, van Duijn CM, Franco OH, Goedegebure A, Ikram MA, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BHC, Tiemeier HW, Uitterlinden AG, Vernooij MW. The Rotterdam Study: 2014 objectives and design update. Eur J Epidemiol 2013; 28:889-926. [PMID: 24258680 DOI: 10.1007/s10654-013-9866-z] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/08/2013] [Indexed: 02/06/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands,
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