Last Updated: 2007-12-11 14:55:33 -0400 (Reuters Health)

NEW YORK (Reuters Health) – Age, morning stiffness, and certain kinds of pain can identify patients at risk for progression of hip osteoarthritis to total hip replacement, according to a report in the December 15th Arthritis & Rheumatism.

The pathogenesis and risk factors for the development of osteoarthritis of the hip have been reviewed, Dr. Annet M. Lievense and colleagues explain, but few studies have examined the variables predicting disease progression.

The research team at Erasmus Medical Center in Rotterdam, The Netherlands, therefore examined changes over time in 224 patients with hip osteoarthritis attending general practices.

Twelve percent of patients received a total hip replacement during 3 years of follow-up because of severe pain and/or disability, the authors report. By 6 years, the fraction had reached 22%.

Visual analog pain scores were higher than 7/10 in 58% of patients at baseline, the report indicates, and the fraction of patients with these high pain scores increased to 68% at 3 years and 69% at 6 years.

Factors that predicted total hip replacement included age of at least 60 years, morning stiffness, and pain in the groin and/or medial thigh. Surgery was also more likely in patients with decreased active extension of the hip, painful passive internal rotation of the joint, and a Kellgren/Lawrence score of at least 2 on radiographic analysis.

"With information obtained from history taking, physical examination, and radiology, we are now better able to identify persons who are at high risk for progression of hip osteoarthritis," the investigators conclude. "This can be helpful not only to inform patients more precisely about the course of their hip pain, but also for future clinical trials."

Arthritis Rheum 2007;57:1368-1374.