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End-stage coxarthrosis and gonarthrosis. Aetiology, clinical patterns and radiological features of idiopathic
J Chitnavis1, J S Sinsheimer, M A Suchard
1Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK and. University of California, Los Angeles, CA, USA.
Insights
Idiopathic osteoarthritis (OA) of the hip and knee is influenced by constitutional factors, not just wear and tear. This study compared hip and knee replacement patients, finding similarities despite differing injury histories.
Area of Science:
- Orthopedics
- Rheumatology
- Epidemiology
Background:
- Idiopathic osteoarthritis (OA) is traditionally linked to environmental 'wear and tear' factors.
- Understanding the etiological background, clinical presentation, and radiological features of hip and knee OA is crucial for effective management.
Purpose of the Study:
- To compare the etiological background, clinical patterns, and radiological features of idiopathic hip osteoarthritis (OA) and knee OA requiring arthroplasty.
- To investigate contributing factors beyond environmental wear and tear in end-stage OA.
Main Methods:
- A survey of 402 Caucasian patients undergoing total hip replacement (THR) or total knee replacement (TKR) for idiopathic OA.
- Analysis of patient demographics, medical history (including previous joint injury), occupational background, body mass index, and clinical/radiological findings.
Main Results:
- Previous joint injury was more frequent in the total knee replacement (TKR) group.
- Both groups showed a female predominance, similar body mass indices, and mixed occupational backgrounds.
- Total knee replacement (TKR) patients had earlier symptom onset than total hip replacement (THR) patients; however, both groups exhibited tendencies for bilateral disease, nodal involvement, and right-sided joint replacements.
Conclusions:
- The findings suggest a significant role for constitutional predisposition in the development of end-stage idiopathic OA.
- Idiopathic OA is not solely attributable to environmental factors, highlighting the importance of genetic or inherent susceptibility.
Objectives:
To determine and compare the aetiological background, clinical patterns and radiological features of idiopathic osteoarthritis (OA) of the hip and the knee warranting arthroplasty.
Methods:
A total of 402 Caucasians consecutively undergoing total hip replacement (THR) or total knee replacement (TKR) for idiopathic OA at a major centre was surveyed.
Results:
Previous joint injury was more common in the TKR group (P < 0.0001). However, both groups manifested a mixed occupational background, body mass indices similar to the general population and a predominance of females (F:M = 1.3-1.4:1). The TKR group had a significantly younger age of symptom onset (56 yr) than the THR group (61 yr) but both groups had a tendency to bilateral arthroplasty (33%), nodal involvement (54-59%), a significant excess of right-sided replacements (1.8:1, THR; 2.2:1, TKR) and similar levels of pre-operative pain and disability. Up to 40% of hips manifested acetabular dysplasia and 10% possible previous slipped upper femoral epiphyses. Eighty-five per cent with end-stage coxarthrosis or gonarthrosis had an identical pattern of radiographic disease contralaterally.
Conclusions:
Our data suggest the importance of a constitutional tendency to idiopathic, end-stage OA, a disorder traditionally associated with environmental factors leading to 'wear and tear'.