Associations of radiological osteoarthritis of the hip and knee with locomotor disability in the Rotterdam Study

Abstract

Objective-To assess the contribution of radiological osteoarthritis of the hips and knees to disabilities in the activities of daily living related to lower limb function. Methods-During a home interview 1156 men and 1739 women, randomly chosen from the source population of all independently living residents aged 55 years and over living in a district of Rotterdam (the Rotterdam Study) were asked about locomotor disability by six questions of the Health Assessment Questionnaire (HAQ) and about pain in the hips and knees in the past month. Radiographs of hips and knees were scored according to the Kellgren grading system for osteoarthritis. Results-The prevalence of locomotor disability, defined as at least some diYculty with three or more out of six lower limb functions, was 20.2% for men and 31.9% for women; hip pain was present in 8.3% of the men and 16.6% of the women; knee pain in 12.6% of the men and 22.3% of the women. The prevalence of radiological osteoarthritis grade 2+ of the hip was 14.1% for men and 15.9% for women, and of the knee 16.3% and 29.1% respectively. The odds ratio (OR) (95% confidence intervals) of hip radiological osteoarthritis for locomotor disability adjusted for age and all other variables was for men: 1.4 (0.9, 2.1) and for women: 2.2 (1.6, 2.9). The ORs of knee radiological osteoarthritis adjusted for age and all other variables were 1.1 (0.9, 2.1) and 1.4 (1.1, 1.8) respectively. Severe radiological osteoarthritis (grade 3+) was stronger associated. The ORs of pain in the hips or knees and morning stiVness were much higher (between 2.7 and 5.5 for men and between 2.1 and 5.1 for women). Conclusions-Radiological osteoarthritis of the hip and knee are only weak independent predictors of locomotor disability in women, and not at all independently associated with locomotor disability in men. Age, pain of the hips and knees, and morning stiVness seem to be the most important independent determinants of locomotor disability. (Ann Rheum Dis 1998;57:203-208) Locomotor disability as defined by the diYculty people experience when carrying out basic activities of daily living related to the lower limbs can be caused by many diseases. In a recent paper we demonstrated the association between locomotor disability and joint pain and morning stiVness.

Systematic Review of the Prevalence of Radiographic Primary Hip Osteoarthritis

“…An additional five studies [7,22,23,38,54] were identified from reference lists of included studies. The 23 studies included 13 cross-sectional studies [1, 7, 9, 19, 23, 27-31, 43, 54, 55], six cohort studies [5,22,44,[47][48][49], one case-control study [3], and three previous review articles on this topic [26,36,38]. Older estimates of the prevalence of radiographic primary hip OA reported in the latter group were used to supplement those uncovered by our electronic search.…”

“…The most common method used to diagnose overall prevalence of radiographic primary hip OA was that of Kellgren and Lawrence (K&L) (n = 23) [5,19,23,26,27,29,33,37,38,43,44,[47][48][49]54] followed by minimum joint space width (JSW) (n = 10) [3,9,26,28,30,43,49] and other classification schemes such as the Croft index (n = 2) [55], the American College of Rheumatology criteria (n = 1) [1], the Atlas of Osteoarthritis criteria (n = 1) [38], and unspecified methods (n = 2) [26]. The CV for the K&L method of diagnosis was 97.4% for K&L Grade C 2 and 73.1% for K&L C 3; the Croft C 3 method of diagnosis had a CV of 113.6%.…”

“…The methodological quality score for the 19 estimates of the prevalence of radiographic hip OA reported in the 16 primary studies [1, 3, 5, 7, 9, 19, 23, 27-30, 43, 44, 47, 54, 55] (three of which [29,43,55] reported on two separate cohorts each) uncovered in this review had a mean of 4.9 with a standard deviation of 0.9, a median of 5.0, and a range from 3.0 to 7.0 (Table 9). Only five of these estimates from four studies [9,[27][28][29] were considered of lower methodological quality (ie, score of 4 or lower), whereas 14 estimates from 12 studies [1,3,5,7,19,23,30,43,44,47,54,55] were considered of higher methodological quality (ie, score of 5 or higher). The mean prevalence reported in studies of lower methodological quality was 5.9% with a standard deviation of 4.0% and a median of 5.3% compared with a mean of 7.4%, a standard deviation of 6.4%, and a median of 6.7% for studies of higher methodological quality.…”

“…The mean prevalence reported in the 18 studies in the former group was 8.7% with a standard deviation of 8.3% and a median of 5.0% compared with a mean of 7.5%, a standard deviation of 5.8%, and a median of 7.0% in the latter group. A small number of studies (n = 9) [1,9,23,28,30,44,54] provided additional information about age beyond simply the minimum required for inclusion and reported prevalence of radiographic primary hip OA in specific age groups (Table 4). Because many of those studies used the same (or similar) 5-year intervals when reporting prevalence for ages 35 to 85+ years, it was possible to examine summary statistics by incremental age group.…”

“…A relatively small number of studies (n = 7) [1,9,23,28,30,44,54] reported the prevalence of radiographic primary hip OA by age group separately for each gender. Because many of these studies used the same (or similar) 5-year intervals spanning ages 35 to 85+ years, it was possible to examine summary statistics by incremental age group.…”