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Risk factors for total hip replacement due to primary osteoarthritis: a cohort study in 50,034 persons
Gunnar B Flugsrud1, Lars Nordsletten, Birgitte Espehaug
1Orthopaedic University Clinic, Ullevål Hospital, Oslo, Norway. Gunnar.Flugsrud@ioks.uio.no
Insights
High body mass index (BMI) and intensive physical activity at work are significant risk factors for total hip replacement (THR) due to osteoarthritis. Reducing these factors may decrease the need for hip surgery.
Area of Science:
- Orthopedics
- Epidemiology
- Public Health
Background:
- Osteoarthritis is a leading cause of disability.
- Total hip replacement (THR) is a common surgical intervention for end-stage osteoarthritis.
- Identifying modifiable risk factors for THR is crucial for prevention strategies.
Purpose of the Study:
- To prospectively identify risk factors for total hip replacement (THR) due to primary osteoarthritis.
- To investigate the association between body mass index (BMI), body weight, physical activity, and THR.
- To inform public health initiatives aimed at reducing the incidence of hip osteoarthritis requiring surgery.
Main Methods:
- Prospective cohort study design.
- Data from a cardiovascular screening were linked with 9 years of national THR data.
- Analysis included 50,034 participants followed for an average of 9 years, with 672 undergoing THR.
Main Results:
- A dose-response relationship was observed between higher BMI and body weight and the risk of THR.
- Intensive physical activity at work, but not leisure activity, was associated with an increased risk of THR.
- The highest BMI quarter showed relative risks of 2.0 (men) and 3.0 (women) for THR; highest body weight showed relative risks of 2.1 (men) and 3.4 (women).
Conclusions:
- High body mass index (BMI) and intensive occupational physical activity are significant risk factors for total hip replacement (THR) due to primary osteoarthritis.
- These modifiable risk factors contribute substantially to the overall burden of hip osteoarthritis.
- Interventions aimed at reducing BMI and modifying occupational physical activity demands may lower the incidence of THR.
Objective:
To identify prospectively the possible risk factors for total hip replacement (THR) due to primary osteoarthritis in a large cohort.
Methods:
Data from a cardiovascular screening were matched with 9 years of national data on THR. Mean age at the start of followup was 54.9 years, and the 50,034 participants were followed up for an average of 9 years. During followup, 672 persons had a first THR due to primary osteoarthritis.
Results:
We found dose-response associations between body mass index (BMI), body weight, and the level of physical activity at work and THR for primary osteoarthritis. The highest versus the lowest quarter of BMI had a relative risk of 2.0 (95% confidence interval [95% CI] 1.4-2.9) among men and 3.0 (95% CI 2.1-4.1) among women. The highest versus the lowest quarter of body weight had a relative risk of 2.1 (95% CI 1.4-3.2) among men and 3.4 (95% CI 2.4-4.9) among women. Intensive versus sedentary physical activity at work had a relative risk of 2.1 (95% CI 1.5-3.0) among men and 2.1 (95% CI 1.3-3.3) among women. No association was found between physical activity in leisure and THR for primary osteoarthritis.
Conclusion:
Intensive physical activity at work and a high BMI each contribute significantly to the overall risk of undergoing THR due to primary osteoarthritis. Lowering the exposure to these risk factors may substantially reduce the need for hip replacement.