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Prevalence of hip pain by age and gender 

Prevalence of hip pain by age and gender 

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The relationship between hip pain and radiographic change in the population is unclear due to lack of agreed definition for hip pain and difficulties in obtaining radiographs from asymptomatic random samples. Our objective was to assess the relationship between hip pain and radiographic change in osteoarthritis (OA) in a population sample aged over...

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... responders comprised 556 males and 515 females. The age-and gender-specific hip pain prevalences are shown in Table 1. Overall, the prevalence was 6.8% in the males and 10.3% in females. ...

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... Semi-quantitative grading of hip OA can be done using Kellgren-Lawrence (KL) [8] or Croft [9] scoring which examine the presence and severity of radiographic characteristic features, including joint-space narrowing (JSN), osteophytes, subchondral scleroisis, and cysts. These criteria are inherently subjective [10], making clinical application difficult [11][12][13]. Although severity grading is traditionally performed by manual inspection of standard radiographs, Yoshida et al. [17] found that this could be performed as accurately using DXA scans. ...
Chapter
Osteophytes are distinctive radiographic features of osteo-arthritis (OA) in the form of small bone spurs protruding from joints that contribute significantly to symptoms. Identifying the genetic determinants of osteophytes would improve the understanding of their biological pathways and contributions to OA. To date, this has not been possible due to the costs and challenges associated with manually outlining osteophytes in sufficiently large datasets. Automatic systems that can segment osteophytes would pave the way for this research and also have potential clinical applications. We propose, to the best of our knowledge, the first work on automating pixel-wise segmentation of osteophytes in hip dual-energy x-ray absorptiometry scans (DXAs). Based on U-Nets, we developed an automatic system to detect and segment osteophytes at the superior and the inferior femoral head, and the lateral acetabulum. The system achieved sensitivity, specificity, and average Dice scores (±std) of (0.98, 0.92, \(0.71\pm 0.19\)) for the superior femoral head [793 DXAs], (0.96, 0.85, \(0.66\pm 0.24\)) for the inferior femoral head [409 DXAs], and (0.94, 0.73, \(0.64\pm 0.24\)) for the lateral acetabulum [760 DXAs]. This work enables large-scale genetic analyses of the role of osteophytes in OA, and opens doors to using low-radiation DXAs for screening for radiographic hip OA. KeywordsComputational anatomyU-NetsOsteophytes segmentationOsteophytes detectionAutomated osteoarthritis risk assessment
... Both systems are inherently subjective [4], contributing to widely varying rHOA prevalence estimates that range from 0.9-27% [5], and though atlases help to reduce ambiguity they cannot prevent it entirely [6]. In addition, lower KL and Croft grades are poorly predictive of disease [7], and show weak and inconsistent associations with hip pain, calling into question their clinical relevance [8][9][10]. This likely reflects not only ambiguity and subjectivity of scoring, but also limitations in how these scores are derived. ...
... There are some similarities in comparing our study with previous studies based on KL grading of radiographs. For example, a primary care study (n ¼ 1496) found an OR of 17.4 (95% CI 3, 102) for hip pain in those with KL grade 4, compared with an OR of 11.8 (8.5-16.4) for hip pain in those with grade 4 using our DXA-based classification [8]. Previous studies found KL grade >2 to be associated with a HR of 12.9 and OR from 13.8-30.6 ...
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Objective Conventional scoring methods for radiographic hip osteoarthritis (rHOA) are subjective and show inconsistent relationships with clinical outcomes. To provide a more objective rHOA scoring method, we aimed to develop a semi-automated classifier based on dual-energy X-ray absorptiometry (DXA) images, and confirm its relationships with clinical outcomes. Methods Hip DXAs in UK Biobank (UKB) were marked up for osteophyte area from which acetabular, superior and inferior femoral head osteophyte grades were derived. Joint space narrowing (JSN) grade was obtained automatically from minimum joint space width (mJSW) measures. Clinical outcomes related to rHOA comprised hip pain, hospital diagnosed OA (HES OA) and total hip replacement (THR). Logistic regression and Cox proportional hazard modelling were used to examine associations between overall rHOA grade (0–4; derived from combining osteophyte and JSN grades), and the clinical outcomes. Results 40 340 individuals were included in the study (mean age 63.7), of whom 81.2% had no evidence of rHOA, while 18.8% had grade ≥1 rHOA. Grade ≥1 osteophytes at each location and JSN were associated with hip pain, HES OA and THR. Associations with all three clinical outcomes increased progressively according to rHOA grade, with grade 4 rHOA and THR showing the strongest association [57.70 (38.08–87.44)]. Conclusions Our novel semi-automated tool provides a useful means for classifying rHOA on hip DXAs, given its strong and progressive relationships with clinical outcomes. These findings suggest DXA scanning can be used to classify rHOA in large DXA-based cohort studies supporting further research, with the future potential for population-based screening.
... In this same study, those with worsening hip structure also had less hip extension, although not significantly so. The presence of structural damage is not tightly linked to hip pain (Birrell et al., 2005;Heerey et al., 2018;Park et al., 2021). Worsening pain has been associated with limited hip extension and external rotation during walking in females with mild to moderate hip OA (Tateuchi et al., 2019). ...
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Background: Individuals with hip osteoarthritis (OA) commonly walk with less hip extension compared to individuals without hip OA. This alteration is often attributed to walking speed, structural limitation, and/or hip pain. It is unclear if individuals who are at increased risk for future OA (i.e., individuals with pre-arthritic hip disease [PAHD]) also walk with decreased hip extension. Objectives: (1) Determine if individuals with PAHD exhibit less hip extension compared to individuals without hip pain during walking, and (2) investigate potential reasons for these motion alterations. Methods: Adolescent and adult individuals with PAHD and healthy controls without hip pain were recruited for the study. Kinematic data were collected while walking on a treadmill at three walking speeds: preferred, fast (25% faster than preferred), and prescribed (1.25 m/s). Peak hip extension, peak hip flexion, and hip excursion were calculated for each speed. Linear regression analyses were used to examine the effects of group, sex, side, and their interactions. Results: Individuals with PAHD had 2.9° less peak hip extension compared to individuals in the Control group ( p = 0.014) when walking at their preferred speed. At the prescribed speed, the PAHD group walked with 2.7° less hip extension than the Control group ( p = 0.022). Given the persistence of the finding despite walking at the same speed, differences in preferred speed are unlikely the reason for the reduced hip extension. At the fast speed, both groups increased their hip extension, hip flexion, and hip excursion by similar amounts. Hip extension was less in the PAHD group compared to the Control group ( p = 0.008) with no significant group-by-task interaction ( p = 0.206). Within the PAHD group, hip angles and excursions were similar between individuals reporting pain and individuals reporting no pain. Conclusions: The results of this study indicate that kinematic alterations common in individuals with hip OA exist early in the continuum of hip disease and are present in individuals with PAHD. The reduced hip extension during walking is not explained by speed, structural limitation, or current pain.
... Chronic hip pain is a prevalent and functionally limiting symptom, which may be due to osteoarthritis, rheumatoid arthritis, osteonecrosis, infectious coxarthrosis, and post-total hip arthroplasty pain [1]. Conservative management includes physical therapy, topical modalities, and nonsteroidal antiinflammatory medications. ...
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Chronic hip pain can be treated with physical therapy, oral medications, injections, and, definitively, total hip arthroplasty. Enough patients have contraindications to and refractory pain even after total hip arthroplasty, that there is a need to develop alternative managements for this disabling condition. This article examines the state of hip radiofrequency ablation literature including relevant anatomy, patient selection, and treatment outcomes.
... Some case reports have described the clinical utility of jiggling exercise for hip OA, such as radiographic changes, increases in joint space width (JSW), and remission of symptoms [8,[10][11][12]. Increased pain in hip OA is strongly associated with reduced JSW values [13][14][15]; therefore, jiggling exercise may be expected to relieve pain in even inoperable patients or patients with poor postoperative progress. However, all past studies investigating jiggling exercises have been performed in outpatient subjects, most of whom took between 1 to 2 years to show improvement in the JSW [10,12]. ...
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... Its prevalence in people over 45 years old is 9.2% [8]-11% [9] (men 7%-8.7%, women 9.3-10% [1,8,10]), reaching 25% by 85 years of age [11]. Not all cases with radiological changes are symptomatic [1,12]. ...
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Chapter
With an aging population, chronic osteoarthritic hip joint pain is becoming a major issue. Most patients with hip pain can control their pain with conservative measures but with a gradual reduction in their quality of life. When gradually reduced ambulation and pain become recalcitrant, total hip arthroplasty is the next step. For most patients, this is a good way to improve pain control and to recover some quality of life, but for a few this aggressive surgical procedure is not possible. Sometimes co-morbidities make total hip arthroplasties undesirable. At other times, the age of the patients recommends to wait for a while. In these cases, other options have to be explored. Percutaneous partial hip joint sensory denervation has become a notable option as it can provide acceptable rates of pain relief with minimal surgical aggressiveness. There are three modalities to perform it: thermal, cooled and pulsed radiofrequency.
... Furthermore, despite hip pain being considered the most common symptom of hip OA, 7 the prevalence of hip pain among individuals with radiographic hip OA and the association of hip pain with the severity of hip OA has been inconsistent among previous studies. 6,[10][11][12][13] To our knowledge, large-scale studies to reveal the epidemiology of hip OA in the Asian population are limited. Additionally, knowledge about the associated factors of painful and painless radiographic hip OA is scarce. ...
... 6,10 The prevalence of symptomatic hip OA in Asian population is lower than that in European and US populations. [11][12][13] Nevertheless, the prevalence of hip pain in the present study (9.7%) was similar to those in studies conducted in European populations (8.5%-13.3%). 13,22 Other studies from the USA have reported a higher prevalence of hip pain (20%-36%). ...
... [11][12][13] Nevertheless, the prevalence of hip pain in the present study (9.7%) was similar to those in studies conducted in European populations (8.5%-13.3%). 13,22 Other studies from the USA have reported a higher prevalence of hip pain (20%-36%). 11,12 This inconsistency between the low prevalence of painful hip OA and high prevalence of hip pain indicates that hip pain from other etiologies may be more common than hip pain originating from hip OA, particularly in women. ...
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Aim: This study aimed to evaluate the prevalence and associated factors of radiographic hip osteoarthritis (OA) in the Korean community-dwelling population. Methods: This study included 11,814 individuals (5025 men and 6789 women) ≥50 years of age from the Korea National Health and Nutrition Examination Surveys. Radiographic hip OA was defined as having a Kellgren–Lawrence grading scale score ≥2. Painful hip OA was defined as radiographic hip OA with the presence of hip pain. The prevalence of radiographic hip OA was evaluated with respect to age group, sex, and presence of hip pain. The associations of sociodemographic and clinical variables with hip OA and hip pain were assessed using multivariable logistic regression analyses. Results: The weighted prevalence of radiographic hip OA and painful hip OA was 1.1% and 0.2%, respectively, in Korea. Older age (≥75 years) and male sex were independently associated with radiographic hip OA and painless hip OA. Comorbid musculoskeletal pain (knee pain) was independently associated with painful hip OA. The difference between painful and painless hip OA was the presence of comorbid musculoskeletal pain (knee pain and low back pain). Although hip pain was more common in women than in men, it was associated with the severity of hip OA only in men. Conclusions: Radiographic hip OA is rare in Korean middle-aged and elderly people. Furthermore, hip pain is infrequent in radiographic hip OA.
... Reliance on the presence of moderate to severe radiographic hip OA severity without other data to inform an appropriateness decision is, in our view, a substantial limitation of the system. For example, some persons with moderate or severe radiographic hip OA have either no pain or mild pain 11,12 . These persons would likely experience minimal or no benefit from hip arthroplasty while also being exposed substantial cost and time loss as well as a risk, albeit a low risk, of serious adverse outcomes and substantial costs. ...
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Objective In late 2017, the American Academy of Orthopaedic Surgeons (AAOS) published an appropriateness classification system using the RAND/University of California, Los Angeles (UCLA) approach for patients with hip osteoarthritis (OA). We determined the contribution of predictor variables in the system to final classification, rated as “appropriate,” “may be appropriate,” or “rarely appropriate” for hip arthroplasty. Methods An AAOS-appointed expert panel developed 270 clinical vignettes incorporating all permutations of 5 evidence-driven indication variables associated with hip arthroplasty outcome or need. Indication variables were age, function-limiting pain severity, radiographic hip OA severity, hip motion, and presence of modifiable prognostic risk factors. Multinomial regression determined the relative contribution of each variable and a classification tree method determined variable combinations contributing to final classification. Results Patient age and hip OA severity were the dominant predictors of appropriateness classification in both statistical models. Function-limiting pain made a slight contribution relative to age and hip OA severity while hip motion and the presence of modifiable prognostic factors did not meaningfully contribute to final classification. The regression model explained about 99% of the variance and the classification tree had an accuracy of 87.8%. Conclusion Classification for hip arthroplasty appropriateness in the AAOS system is driven almost exclusively by age and OA severity. Function-limiting pain, a major reason patients seek surgery, contributes only slightly to the AAOS appropriateness criteria. The system relies heavily on traditional variables of patient age and radiographic hip OA severity. Future study of actual patient outcomes is needed to further test the validity of the AAOS system.
... deformity of the femoral head and formations of osteophytes. However, 'minor' morphological changes observed in radiographs do not necessarily lead to hip pain (Birrell et al. 2005). Thus, the disease is often diagnosed after the symptoms are irreversible. ...
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Radiological and pathological characteristics of hip osteoarthritis (OA) is joint-space loss due to degradation of articular cartilage. However, patients with early-stage OA do not yet show any radiological signs, which leaves them without diagnosis and treatment. This study evaluates the potential of a novel tool to identify pre-radiographic OA changes based on hip bone morphology. Two statistical appearance models for femur and pelvis were used to estimate the 3Dmorphology of the hip bones based on planar radiographs from patients. Well-known hip geometrical parameters (n = 22) were computed from patient CT scans (truth), 3D reconstructions (new method) and radiographs (calculated manually). The methods were compared by measuring relative error to truth. The new method was significantly more accurate in calculating hip geometrical parameters than the manual 2D calculations. The proposed approach could also capture rotational parameters like cross-over sign and anterior wall sign (100% correct predictions). The method can successfully reconstruct 3D hip shapes and densities for patients that have not yet developed severe osteoarthritis, and provided higher precision than manual estimations. Thus, it may be used to calculate morphological parameters that are predictors of OA and can become a powerful tool in human hip OA research and diagnostics.
... The predictive factors we identified to be associated with the development of hip OA are consistent with the previous literature. Morning stiffness and limited internal rotation are known predictors for total hip replacement in primary care [14,15]. Age and pain levels, however, were not statistically significant in the final model in the current study whereas other studies found these to be predictive [14,15]. ...
... Morning stiffness and limited internal rotation are known predictors for total hip replacement in primary care [14,15]. Age and pain levels, however, were not statistically significant in the final model in the current study whereas other studies found these to be predictive [14,15]. This could be explained by our relatively young cohort with generally quite low pain levels (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score 27.2 on a scale of 0-100, numeric rating scale (NRS) 3.7, Table 1) such as can be expected in a cohort with early OA. ...
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Background: We aimed to evaluate the prevalence of hip and knee osteoarthritis (HOA and KOA) according to American College of Rheumatology (ACR) criteria among participants with suspected early symptomatic osteoarthritis (OA) in the CHECK cohort. We also assessed whether participants not fulfilling ACR criteria at baseline develop ACR-defined OA at 2-year and/or 5-year follow up, and which baseline factors are associated with this development. Methods: The CHECK cohort included 1002 subjects with first presentation of knee and/or hip complaints. The primary outcome was onset of HOA and/or KOA according to the ACR criteria, including the clinical classification criteria and the combined clinical and radiographic classification criteria at 2-year and/or 5-year follow up. Results: Of the participants with hip complaints, 63% (n = 370) were classified as having HOA at baseline according to the ACR criteria. Of those not classified with HOA at baseline, 40% developed HOA according to the clinical or combined clinical/radiographic ACR criteria after 2 and/or 5 years. Up to 92% of participants (n = 829) with knee complaints were classified as having KOA at baseline; of those not classified with KOA at baseline, 55% developed KOA according to the clinical ACR criteria or the clinical/radiographic ACR criteria after 2 and/or 5 years. The following factors were associated with development of HOA: morning stiffness (OR 2.39; 95% CI 1.14-4.98), painful internal rotation (OR 2.53; 95% CI 1.23-5.19), hip flexion < 115° (OR 2.33; 95% CI 1.17-4.64) and erythrocyte sedimentation rate (ESR) < 20 mm/h (OR 2.94; 95% CI 1.13-7.61). No variables were associated with development of KOA at 2-year and/or 5-year follow up. Conclusions: A large proportion of persons with hip complaints not fulfilling the ACR criteria at baseline develop HOA after 2 and/or 5 years of follow up. Almost all persons with knee complaints already fulfill the clinical and/or radiographic ACR criteria for OA, and half of the persons not fulfilling criteria at baseline will do so after 5 years of follow up. Several individual ACR criteria for HOA at baseline were associated with the development of HOA at follow up. This association was not proven for KOA, probably because of the small number of subjects developing KOA in this study.