Role of radiography in predicting progression of osteoarthritis of the hip: prospective cohort study

doi:10.1136/bmj.38442.457488.8F

BMJ 2005;330:1183 (21 May), doi:10.1136/bmj.38442.457488.8F (published 13 May 2005)

Paper

Role of radiography in predicting progression of osteoarthritis of the hip: prospective cohort study

Max Reijman, clinical epidemiologist¹, J M W Hazes, professor of rheumatology¹, H.A.P Pols, professor of internal medicine¹, R M D Bernsen, statistician¹, B W Koes, professor of general practice¹, S M A Bierma-Zeinstra, biomedical scientist¹

¹ Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, Netherlands

Address for correspondence: M Reijman m.reijman{at}erasmusmc.nl

Objectives To investigate which variables identify people athigh risk of progression of osteoarthritis of the hip.

Design Population based cohort study.

Setting Ommoord district in Rotterdam, Netherlands.

Participants 1904 men and women aged 55 years and older fromthe Rotterdam study were selected on the basis of the presenceof osteoarthritic signs on radiography at baseline, as definedby a Kellgren and Lawrence score $≥$ grade 1.

Main outcome measures Radiological progression of osteoarthritisof the hip, defined as a decrease of joint space width ( $≥$ 1.0mm) at follow-up or the presence of a total hip replacement.

Methods Potential determinants of progression of hip osteoarthritiswere collected at baseline. x Ray films of the hip at baselineand follow-up (mean follow-up time 6.6 years) were evaluated.Multivariate logistic regression models were used to assessthe association between potential risk factors and progressionof hip osteoarthritis.

Results In 13.1% (1904 subjects) of the study population (meanage 66.2 years), progression of hip osteoarthritis was evidenton the radiograph. Starting with a simple model of only directlyobtainable variables, the Kellgren and Lawrence score at baseline,when added to the model, was a strong predictor (odds ratio5.8, 95% confidence interval 4.0 to 8.4), increasing to 24.3(11.3 to 52.1) in subjects with hip pain at baseline.

Conclusions The Kellgren and Lawrence score at baseline wasby far the strongest predictor for progression of hip osteoarthritis,especially in patients with existing hip pain at baseline. Inpatients with hip pain, a radiograph has strong additional valuein identifying those at high risk of progression of hip osteoarthritis.

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