medwireNews: Comorbidity, Kellgren–Lawrence grade, superior or superolateral femoral head migration, and subchondral sclerosis may each predict progression among patients with hip osteoarthritis (OA), show the results of a systematic review.
The review, conducted by Carolien Teirlinck (Erasmus University Medical Center, Rotterdam, the Netherlands) and colleagues, included 57 studies published up to March 2019 that evaluated associations between patient, health, and diagnostic variables and progression of hip osteoarthritis, defined as clinical or radiologic progression, or need for total hip replacement.
Among the 57 studies, the researchers identified 154 variables that could potentially predict disease progression. Half of these were disease characteristics, 35% were chemical or imaging markers, and the remainder were patient-related variables.
However, just one – comorbidity – predicted clinical progression with a strong level of evidence, which was defined as consistent findings (≥75% of the studies showing the same direction of the association) in two or more studies with a low risk of bias in all six domains of the QUIPS bias assessment tool.
There was also strong evidence that a higher Kellgren–Lawrence grade, superior or superolateral femoral head migration, and subchondral sclerosis predicted faster progression or more patients progressing to total hip replacement, but there were no strong indicators of radiologic progression.
Conversely, however, there was strong evidence suggesting there was not an association between radiologic progression and the markers C-terminal telopeptide of collagen type I, cartilage oligomeric matrix protein, N-terminal telopeptide of collagen type I, and N-terminal propeptide of procollagen type I and type III.
In addition, sex, social support, pain medication, quality of life, and limited range of motion of internal rotation or external rotation did not predict clinical progression, while BMI was not associated with progression to total hip replacement.
For the remaining factors, there was only moderate, limited, or conflicting evidence to suggest that they predicted or did not predict progression.
Writing in Arthritis Research & Therapy, Teirlinck and co-authors note that heterogeneity among the studies was too high to perform a meta-analysis meaning they “were bound to a best-evidence synthesis and unable to calculate the strengths of the associations.”
“This limits the translation to the daily clinical practice,” they remark.
The team therefore says that “more high-quality research focusing on the prognostic factors in hip OA” is still needed so that healthcare professionals can identify patients more likely to progress rapidly and who “may need an intensified symptomatic treatment or early referral to an orthopedic surgeon.”
By Laura Cowen
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Arthritis Res Ther 2019; 21: 192