but they include fracture and rheumatoid arthritis. c) Incidence of Bilateral Coxarthrosis. Fifty-seven patients (27 males and 30 females) of the total series of Insights into the aetiology of idiopathic coxarthrosis and gonarthrosis have The proportion with uni‐ or bilateral disease and localized or generalized OA is.
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Aetiology, clinical patterns and radiological bulateral of idiopathic osteoarthritis, RheumatologyVolume 39, Issue 6, 1 JunePages —, https: To determine and compare the aetiological background, clinical patterns and radiological features of idiopathic osteoarthritis OA of the hip and the knee warranting arthroplasty.
However, both groups manifested a mixed occupational background, body mass indices similar to the general population and a predominance of females F: Most cases of osteoarthritis OAthe commonest of the arthropathies, are idiopathic. Joints prone to symptomatic OA include the hip and the knee. Insights into the aetiology of idiopathic coxarthrosis and gonarthrosis have coxartroosis gained by epidemiological surveys on asymptomatic radiographic disease [ 3 ].
These investigations have implicated age, gender, race, obesity, occupation, injury, heredity and developmental deformity as likely risk factors for OA. There are differences in the importance of these factors to hip and knee OA, with injury and obesity, for example, associated with gonarthrosis whilst occupation and dysplasia are associated with coxarthrosis.
Studies exploring the importance of such factors in symptomatic OA have been limited by size [ 4 ], the inclusion of cases with secondary OA [ 5 ] and the exclusion of female patients [ 6 ].
Despite the prevalence of coxarthrosis and gonarthrosis, no one study has compared possible aetiological factors for these conditions. Indeed, risk factors for asymptomatic OA might be different to those for symptomatic disease. Rates of disease progression from symptom onset to arthroplasty remain unclear.
The nature and duration of joint pain and associated disability are factors determined in everyday clinical practice but are hardly discussed in the literature. There is little published coxaftrosis on the intrajoint localization of gonarthrosis requiring arthroplasty. The medical records and available radiographs coxartrois all patients undergoing a primary or revision THR or TKR at the Nuffield Orthopaedic Centre, Oxford, a national centre for joint replacement, between August and April were reviewed to determine indications for primary replacement.
From a total of consecutive cases, were excluded. The most important criterion for selection into the study was an absence of a definite identifiable cause for OA in the joint s replaced. The selection criteria bklateral and the reasons for exclusions have been detailed in a previous publication [ 15 ]. In the days following arthroplasty, patients were invited to participate in an interview designed to ascertain disease associations and clinical patterns.
Interviews were conducted by a single researcher. Coxartroiss patients who could not be interviewed prior to departure from hospital were telephoned and taken through the same questionnaire as those reviewed in hospital. Although CART ranks variables by importance, it does not assign bilatral significance.
Therefore, once CART was used to select covariates, we used regression to assess the model. Linear and logistic regression analyses were performed using STATA statistical analysis package, version 5. Available standard hip and coxzrtrosis radiographs taken immediately prior to arthroplasty were obtained from hospital records.
The severity of OA for the hip and tibiofemoral joints was scored using the Kellgren and Lawrence scheme [ 18 ], whilst the scheme of Burnett et al. Tables 1 and 2 show the results of univariate analyses for aetiological associations and clinical patterns.
Tables 3 and 4 show the results of the radiographic survey of coxarthrosis and gonarthrosis. The results from multivariate analyses of aetiological associations are given in Appendix 2. Whilst all joints had sclerosis, there was none with fracture or avascular necrosis. One hip manifested protrusio acetabulae whilst another had chondrocalcinosis. All knees manifested sclerosis. There were no cases of fracture, avascular necrosis or dysplasia.
Our finding that patients with gonarthrosis develop symptoms in advance of those with coxarthrosis might partly account for the large unmet demand for TKR [ 20 ]. High perimenopausal oestrogen levels might predispose women to OA [ 23 ].
Oestrogen receptors present in articular cartilage could potentiate cytokines involved in cartilage metabolism [ 24 ] and gender differences exist in the prevalence of these receptors in articular cartilage [ 25 ].
Although the most common occupations presenting for THR and TKR included farming, a large proportion were administrators and teachers, suggesting that those in lighter occupations are also vulnerable to OA. A history of a previous injury to the joint replaced was more than five times more common in the TKR than in the THR group. Further to other studies implicating menisectomy as a risk factor for gonarthrosis [ 529 ], nearly one in five men and one in 10 men or women undergoing TKR had previously undergone ipsilateral menisectomy.
Furthermore, the proportion with a history of menisectomy in the TKR group was significantly greater than that in the THR group, suggesting direct association between menisectomy and gonarthrosis. Further to previous work showing that bilateral radiographic changes are common in those with symptomatic coxarthrosis and gonarthrosis [ 3031 ] our results indicate that between a quarter and a third of patients with THR or TKR had bilateral replacements at survey.
Moreover, nearly one fifth of those with unilateral THR admitted to chronic contralateral hip pain whilst two fifths of those with unilateral TKR had chronic pain in the opposite knee.
Whether coxarthrosis and gonarthrosis occur together or independently has been debated [ 32 ].
Coxa Vara Bilateral y Coxartrosis.JPG
In our survey, a quarter of those with THR manifested chronic knee pain whilst an eighth of those with TKR had chronic hip pain. Knee and hand OA have been previously associated and are implicated more often in the presentation of generalized disease than hip OA [ 2231 ].
As distal interphalangeal nodal arthropathy suggests polyarticular disease, our results imply that more than a half of those undergoing either TKR or THR manifested generalized OA [ 7 ].
Women were bilaterxl likely to admit rest pain or night pain. Women were more likely to have used analgesics than men. Our study confirms the predominance of superior joint localization noted by previous workers [ 22coxartrisis ]. Concentric disease was present in over half of all cases, a far greater proportion than in previous studies on less severe coxarthrosis [ 12 ] implying that localized OA progresses to involve the entire joint.
Women had a tendency to superolateral OA and men to superomedial OA [ 111235 ].
[The treatment of bilateral coxarthrosis].
If extrinsic influences such as injury were predominant then differences in the localization of OA might have been expected in adjacent hips. The fact that subjective assessment failed to detect dysplasia, except for coxa valga deformity in one hip, suggests that acetabular dysplasia can be overlooked unless the CEA is measured.
Murray [ 14 ] suggested that ratios greater than 1. Our patients had a mean FHR of 1. Our results suggest that the FHR is less repeatable than the CEA and might therefore be less useful in clinical practice. The same proportion of men and women were affected by medial tibiofemoral OA but women were three times more at risk of predominant patellofemoral OA.
Bilateral radiographic OA was present in nearly two thirds of cases, with symmetrical patterns of intrajoint localization nearly universal. The tendency to symmetrical disease is suggestive of an inherent predisposition to knee OA. Concurrent medical conditions, as well as health service variations in the practice and provision of arthroplasty might have influenced the composition of our patient sample.
Although personal experience suggests that patient selection criteria for THR and TKR are broadly similar across the UK, further studies conducted in other countries will be necessary to validate our results. However, the capacity of patients to remember past events was generally good. Correlation coefficients in excess of 0. Errors could also have resulted from the overweight underestimating their weight and in the misclassification of occupational strength demands.
Furthermore, the obese could have been denied surgery. Moreover, at our centre, few are denied arthroplasty because of obesity. Similarities between those with coxarthrosis and gonarthrosis included a predominance of females; previous occupational demands featuring those with both heavy and light physical duties and a rise in BMI with age, comparable bilateraal the general population. Similar degrees of pain and disability were experienced by the two groups with women admitting more joint pain than men.
Although superior joint localization prevailed in those with coxarthrosis, more than half manifested a concentric pattern of OA. The severity of OA was less marked in the patellofemoral and lateral tibiofemoral compartments. Our findings support suggestions that idiopathic coxarthrosis is often associated with subtle and bilateral deformities of the hip joint. The date of birth, year bilatwral onset of symptoms of arthritis in the joint most recently treated by primary arthroplasty and the year of primary arthroplasty for that joint.
In cases of bilateral replacement, these details were obtained for the joint which had developed symptoms earliest. Patients were asked to estimate their: Patients’ current weights were obtained from hospital records. The nature and duration of the occupation s undertaken by patients in their lifetimes were recorded.
Periods ocxartrosis service less than 6 months were ignored. We modified the Nordic Occupational Classification used by Vingaard [ 6 ] to estimate occupational risks for hip and knee OA by including white collar workers. Patients with an injury to either hip or knee which prevented them from walking normally for a period of at least 1 week were asked to identify the joint injured, the date of the injury and coxarrosis any surgical intervention to the coxartrosi following the injury.
Factors aggravating hip and knee pain, night pain and analgesic use were determined. The site of chronic joint pain, as defined by pain for at least 6 months within the previous year, was recorded. Compared with those undergoing THR, a lower age at symptom onset, previous joint injury, higher BMI and a greater occupational sum score were associated more strongly with those undergoing TKR.
The overall adjusted r 2 was 0. The best predictive linear regression equation was. Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Close mobile search navigation Article navigation. Aetiology, clinical patterns and radiological features of idiopathic osteoarthritis J.
RheumatologyVolume 39, Issue 6, 1 JunePages —, https: The epidemiology of osteoarthritis in the peripheral joints. Kohatsu N, Schurman D. Risk factors for the development of osteoarthrosis of the knee. Clin Orthopaed Rel Res. Aetiological factors in severe osteoarthritis of the knee.
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Overweight predisposes to coxarthrosis. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Kellgren J, Lawrence J.