Systematic review results published in Arthritis Research & Therapy identified 4 prognostic factors for the progression of hip osteoarthritis (OA): disease comorbidity, higher baseline Kellgren and Lawrence grade, superior lateral femoral head migration, and subchondral sclerosis. In addition, 12 candidate prognostic factors were found to have no association with the progression of hip OA.
Investigators conducted a literature search from inception until March 2019 of EMBASE, MEDLINE® (OvidSP), Web of Science, Cochrane Library, PubMed publisher, and Google Scholar. Eligible studies indicated the prognostic factors for progression of hip OA, determined radiographically or clinically. Researchers excluded studies with <1 year of follow-up. They assessed risk for bias according to the Quality in Prognostic Studies tool.
Investigators characterized prognostic factors as having positive, negative, or no association with the progression of hip OA. They conducted evidence synthesis separately for radiologic outcomes, clinical outcomes, and progression to total hip replacement. Owing to the high between-study heterogeneity, researchers performed best-evidence synthesis. They denoted associations as having “strong evidence” if findings were consistent across ≥75% of studies.
Of the 6429 citations identified in the literature search, researchers selected 57 for analysis. They included a total of 103 possible prognostic factors in the best-evidence synthesis. Investigators found strong evidence of an association between progression to total hip replacement and the following characteristics: higher baseline Kellgren and Lawrence grade, superior lateral femoral head migration, and subchondral sclerosis. Strong evidence also suggested more clinical progression in patients with comorbidity. Researchers found strong evidence of no association with clinical progression for sex, social support, use of pain medication at baseline, quality of life at baseline, and limited range of hip motion. In addition, they did not find any association between radiologic progression and the following biomarkers: 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.
Researchers identified 4 prognostic factors in hip OA using data from 57 peer reviewed studies. They also categorized 12 factors as having no association with progression; however, limited evidence was available for the majority of prognostic factors.
“Health professionals caring for patients with hip OA will benefit from the insight in prognostic factors, [eg], patients more likely to progress rapidly may need an intensified symptomatic treatment or early referral to an orthopedic surgeon. For this, we still need more high-quality research focusing on the prognostic factors in hip OA,” the researchers concluded.