Association between hip pain and radiographic hip osteoarthritis in primary care: the CHECK cohort

Abstract

Background: The diagnosis of hip osteoarthritis is often based on clinical symptoms, such as pain and stiffness, and radiographic features. However, the association between hip pain and radiographic hip osteoarthritis (ROA) remains uncertain. Aim: To examine the association between hip pain and hip ROA. Design and setting: Cross-sectional analysis of a Dutch cohort, the Cohort Hip and Cohort Knee (CHECK) study. Methods: Participants (45-65 years) experienced hip and/or knee pain for which they had no prior consultation or were within 6 months of their first consultation to a general practitioner. Using weight-bearing anterio-posterior pelvis radiographs, definite and early-stage hip ROA were defined as Kellgren and Lawrence grade ≥2 and ≥1, respectively. Presence of ROA and pain was assessed in both hips of all participants. We assessed the association between hip pain and ROA using generalized estimating equations. Results: The prevalence of definite ROA was 11.0% (218/1982 hips), while the prevalence in painful and pain-free hips was 13.3% (105/789) and 9.5% (113/1193), respectively. The early-stage prevalence was 35.3% (700/1982 hips), 41.2% (325/789) among painful and 31.4% (375/1193) among pain-free hips. Compared to pain-free hips, the odds ratio of painful hips was 1.51 (95% CI 1.16-1.98) for definite and 1.47 (95% CI 1.24-1.75) for early-stage ROA. Conclusion: Hip pain was associated with definite and early-stage hip ROA, yet the overall ROA prevalence was modest and the prevalence among pain-free hips was substantial. Therefore, radiographs hardly help to identify hip OA patients among patients who recently newly presented with hip or knee complaints.

Effect of spinal fusion on joint space narrowing of the hip: comparison among non-fusion, short fusion, and middle or long fusion

“…Third, we could not evaluate hip pain because of the retrospective study design. Hip pain is a chief symptom of hip OA; however, the precise association between hip OA and pain remains unclear [ 37 – 40 ], and most individuals with hip pain do not have radiographic hip OA [ 38 , 41 ]. Thus, we believe that the evaluation of hip pain is not relevant to this study.…”

Risk Factors and Population-Attributable Fractions for Incident Hip Osteoarthritis

“…We found female sex to be the only risk factor statistically significantly associated with both incident clinical and radiographic hip OA. This might not be surprising, given the inconsistency in reported cross-sectional associations between hip symptoms and radiographic hip OA [ 3 , 8 , 10 , 19 ] and the low prevalence of radiographic hip OA in patients consulting for hip pain [ 21 ]. Recent systematic reviews showed that hip shape morphologies were strong risk factors for radiographic hip OA but also confirmed a lack of knowledge on the association between hip shape morphologies and clinical definitions of hip OA [ 4 , 25 ].…”

Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 3: Rehabilitation and Exercise

“…Furthermore, startling language and images of “bone-on-bone” disease can have nocebo effects. In fact, there is substantial discordance between radiographic severity and pain experience [38,48], and exercise therapy can be effective, irrespective of radiographic severity [25,32,53]. Effectiveness depends on establishing a dosage of exercise therapy sufficient for strengthening and including neuromuscular training for the modification of aberrant movement patterns.…”