Identifying Patients at High Risk

Photo: An elderly woman being examined

Identifying patients whose hip OA
may worsen; © Picture Disk

Osteoarthritis (OA) of the hip is a growing problem that will continue to increase as the population ages. In order to examine the factors that might predict its prognosis Sita M.A. Bierma-Zeinstra and Annet M. Lievense of Erasmus Medical Center, Rotterdam, The Netherlands, studied 227 patients who visited their general practitioners in 1996 because of hip pain.

Patients were questioned about the severity of their hip pain and their general health, underwent a physical exam, had X-rays of the pelvic area and sonograms of the hip area. Three years later, the same patients underwent follow-up, during which they were interviewed in person about the progression of their hip pain and whether or not they received a THR. In addition, their OA was assessed using the WOMAC Osteoarthritis Index. After another three years, a comparable follow-up was carried out using a survey that was mailed to the patients.

The results showed that after three years, 12 percent of the patients underwent a THR because of severe pain and/or disability due to hip OA. After six years, this number increased to 36 percent. In addition, another 3 percent to 5 percent had severe pain or disability due to the condition. Being at least 60 years old, morning stiffness, pain in the groin, restricted extension and painful rotation of the hip joint were all associated with an increased risk for undergoing THR.

Earlier studies reported a connection between baseline hip pain and progression of OA, but the current study did not find this to be the case. The authors suggest this may be because all of the patients in their study already had hip pain. Also, obese patients tended to have a decreased risk of THR after three years, which may be attributable to the fact that these patients are typically advised to lose weight before undergoing the surgery.

“With information obtained from history taking, physical examination, and radiology, we are now better able to identify persons who are at high risk for progression of hip OA,” the authors conclude. “This can be helpful not only to inform patients more precisely about the course of their hip pain, but also for future clinical trials.”; Source: Wiley-Blackwell