Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors

doi:10.1016/S0002-9343(02)01447-X

The American Journal of Medicine

Volume 114, Issue 2, 1 February 2003, Pages 93-98

https://doi.org/10.1016/S0002-9343(02)01447-X Get rights and content

Abstract

Purpose

We studied whether several modifiable factors were associated with the risk of total hip replacement due to hip osteoarthritis among women.

Methods

We identified 568 women from the Nurses’ Health Study who reported total hip replacement due to primary hip osteoarthritis on questionnaires from 1990 to 1996, using a validated algorithm. The relation of potential risk factors, such as age, body mass index, physical activity, smoking, alcohol intake, and hormone use, to hip replacement was assessed using pooled logistic regression models.

Results

Higher body mass index was associated with an increased risk of hip replacement due to osteoarthritis (P for trend = 0.0001). Compared with women in the lowest category of body mass index (<22 kg/m²), those in the highest category of body mass index (≥35 kg/m²) had a twofold increased risk (95% confidence interval [CI]: 1.4 to 2.8), whereas those in the highest category of body mass index at age 18 years had more than a fivefold increased risk (95% CI: 2.5 to 10.7). Age also had a positive association; women aged ≥70 years were nine times more likely to have hip replacement than those aged <55 years (95% CI: 5.4 to 13.9). Recreational physical activity, smoking, alcohol use, and postmenopausal hormone use were not associated with an increased risk of hip replacement.

Conclusion

In the Nurses’ Health Study, higher body mass index and older age significantly increased the risk of total hip replacement due to osteoarthritis. Part of this risk appeared to be established early in life.

Section snippets

Methods

The Nurses’ Health Study is a prospective cohort of 121,701 female nurses who were aged 30 to 55 years in 1976. Information on diseases, lifestyle, and health practices is collected from the subjects via biennial questionnaires, with a response rate of greater than 90% for each questionnaire.

We used self-reported total hip replacement on the 1990 to 1996 questionnaires as a surrogate for clinically severe primary hip osteoarthritis. We mailed a supplementary questionnaire to all participants

Results

Of the 1435 women who reported hip replacement from 1990 to 1996, 1142 (80%) responded to the supplemental questionnaire to confirm the diagnosis of primary osteoarthritis. Of these, 871 women (76%) reported hip replacement due to osteoarthritis. We excluded 137 women who had surgery before 1990 and 166 who had cancer or cardiovascular disease, leaving 568 cases for analysis.

Women with higher body mass index were less likely to take postmenopausal hormones, exercise, drink alcohol, or smoke

Discussion

In a cohort of more than 93,000 female nurses, we found that high body mass index was a risk factor for total hip replacement due to osteoarthritis. In addition, a substantial risk associated with body mass index was established early in life; even modest increments in body mass index at age 18 years were associated with a greater risk of future hip replacement. Unlike some studies 17, 20, 26, 27, 28, 29, 30, we found no association between hip replacement due to osteoarthritis and

Acknowledgements

We wish to thank the dedicated nurses in the Nurses’ Health Study who have now participated in the study for more than 25 years. We also thank Julie Herbstman for her assistance, Drs. Piran Aliabadi and John Carrino for reviewing the radiographs, and Dr. Jeffrey Katz for reviewing the manuscript.

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Citation Excerpt :
Indeed, aberrant loading of joints has been identified as an important risk factor of the progression of knee osteoarthritis (Waller et al., 2011) due to a number of factors, including varus-valgus misalignment and anterior cruciate ligament rupture (Andriacchi et al., 2004; Brouwer et al., 2007; Sharma et al., 2001). Even though this is still a contentious topic (Felson, 2000; Reijman et al., 2006), excessive joint loading as a result of obesity has been related to joint degeneration as reported for hip osteoarthritis (Cooper et al., 1998), total hip replacement (Karlson et al., 2003) and tibiofemoral misalignment (Felson et al., 2004). Unloading of joints has been proposed as a conservative treatment to osteoarthritis progression (Lafeber et al., 2006) and interventions focus on weight loss and gait retraining (Shull et al., 2013).
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^☆: Supported by grants AR42630, CA87969, AR36308, and K08 AR 02074-1 from the National Institutes of Health, Bethesda, Maryland. Dr. Karlson is the recipient of an Arthritis Foundation Investigator Award. Dr. Mandl is a recipient of an Arthritis Foundation Physician Scientist Award.

^†: Deceased. Formerly from the University of Munich, School of Medicine.

View full text

Clinical studyTotal hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors☆

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Acknowledgements

The effects of specific medical conditions on the functional limitations of elders in the Framingham Study

Am J Public Health

The economics of osteoarthritis

Osteoarthritis in patients and populations

BMJ

Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work

Am J Epidemiol

Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study

Ann Intern Med

The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study

Arthritis Rheum

Risk factors for incident radiographic knee osteoarthritis in the elderlythe Framingham Study

Arthritis Rheum

Incidence and risk factors for radiographic knee osteoarthritis in middle-aged womenthe Chingford Study

Arthritis Rheum

Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee

Epidemiology

The association of obesity with joint pain and osteoarthritis in the HANES data

J Chronic Dis

Osteoarthritis and obesity in the general population. A relationship calling for an explanation

J Rheumatol

Overweight predisposes to coxarthrosis. Body-mass index studied in 239 males with hip arthroplasty

Acta Orthop Scand

Factors associated with hip osteoarthritisdata from the First National Health and Nutrition Examination Survey (NHANES-I)

Am J Epidemiol

Association of overweight, trauma and workload with coxarthrosis. A health survey of 7,217 persons

Acta Orthop Scand

Biomechanical aspects of occupation and osteoarthritis of the hipa case-control study

J Rheumatol

Lifestyle factors and hip arthrosis. A case referent study of body mass index, smoking and hormone therapy in 503 Swedish women

Acta Orthop Scand

Individual risk factors for hip osteoarthritisobesity, hip injury, and physical activity

Am J Epidemiol

Risk factors for total hip replacement due to primary osteoarthritisa cohort study in 50,034 persons

Arthritis Rheum

Clinical and radiological survey of the incidence of osteoarthrosis among obese patients

Ann Rheum Dis

Clinical study
Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors☆