Disabling hip osteoarthritis: gender, body mass, health and functional status correlates

doi:10.4236/health.2010.27106

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Vol.2, No.7, 696-704 (2010)

doi:10.4236/health.2010.27106

Health

Disabling hip osteoarthritis: gender, body mass, health

and functional status correlates

Ray Marks

School of Health & Behavioral Sciences, City University of New York, York College, and Department of Health & Behavior Studies,

Columbia University, Teachers College, New York, USA; rm226@columbia.edu

Received 12 February 2010; revised 15 March 2010; accepted 16 March 2010.

ABSTRACT

Objective: To examine gender differences in

self-reported pain and function before and after

hip replaceme nt surger y and the extent to which

overweight, comorbidities and muscular status

impact pain and function in adults with disab-

ling end-stage hip joint osteoarthritis. Setting:

Orthopedic Hospital Setting on the East Coast

of the United States. Study Design: Cross-sec-

tional retrospective chart review. Methods: The

desired demographic, physical and psycho-

logical attributes of 1040 adults with end-stage

hip osteoarthritis hospitalized for hip surgery

were recorded and subjected to comp arison and

correlational analyses. These data included ge n-

der, self-reported weight, height, numbers and

nature of physical and psychological comorbid-

ities, pain intensity, ambulatory capacity and

discharge destination. Sub-group analyses of

808 candidates hospitalized for primary unilat-

eral surgery were also conducted using SPSS

16. Results: There were significant (p < 0.05) as-

sociations between gender, pain scores, co-

morbidity numbers and ambulatory capacity.

Specifically, women who exhibited higher co-

morbid disease rates than men, exhib ited higher

pre-surgery pain levels and greater functional

limitations in walking ability before and after

surgery than men with the same condition. In

sub-group analyses of men and women with the

same mean age, comorbid prevalence rates,

and body mass indices, women were found to

have significantly higher ideal weights on av-

erage than men, and those with higher ideal

weights recovered more slowly after surgery (p

< 0.05). Conclusion: The presentation of hip

joint osteoarthritis is not uniform, and may be

impacted differentially by gender. Women with

high ideal body weights, may be specifically

impacted. Whether genetic or other factors ac-

count for gender differences in pain and func-

tion among adults with disabling hip osteoar-

thritis observation needs to be examined.

Keywords: Body Mass; Comorbidity; Function;

Gender; Hip Joint; Osteoarthritis

1. INTRODUCTION

Hip joint osteoarthritis, a prevalent medical condition,

causes considerable distress and chronic disability amon g

community-dwelling adults aged 55 years and older in

all countries. Associated with substantial direct as well

as indirect costs, a number of factors other than aging

may influence its impact. These factors include the

presence of one or more comorbid health conditions [1]

varying degrees of pain [2], variations in the disease

itself [3], gender [4], high body weights [5], as well as

proprioceptive, muscle strength and hip flexion range of

motion deficits. In addition, prior musculoskeletal inju-

ries, excessive occupational stresses and systemic factors

may impact the severity of osteoarthritis [5].

Because hip osteoarthritis, a leading cause of func-

tional disability [4] is related to poor-self related health

[6], and causes great suffering, but is often approached

quite uniformally as far as treatment is concerned [7], it

was felt a better understanding of the disease and its

clinical heterogeneity [8] might prove beneficial. In par-

ticular, it was felt that if further evidence for important

subsets in the expression of the disease could be identi-

fied, more targeted efforts to reduce the significant social

and economic burden of the disease might be forthcom-

ing in the future. Factors such as prevailing mental and

physical impairments, other than hip osteoarthritis and

their interaction with pain and functional capacity have

also received limited attention in the related literature

[3].

To bridge this gap, th is work examined the associatio n

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between gender, pain and function and potentially pre-

ventable or treatable comorbid health conditions, obesity,

and lower leg weakness as experienced by a hospitalized

cohort of community dwelling adults with end-stage hip

osteoarthritis. More specifically, this analysis attempted

to discern if there are any clinically relevant gender dif-

ferences in the pain experience and functional status of

individuals of similar sociodemographic backgrounds

and disease severity, and whether this was impacted by

the presence of prevailing age, body mass, comorbid

health conditions, and other factors such as muscle

strength capacity.

The primary research questions driving this investiga-

tion were the following:

1) Is the extent of the disability ex perienced by adults

with disabling hip joint osteoarthritis similar for men and

women?

2) What coexisting health conditions are most com-

monly observed among community dwelling adults with

end stage hip joint osteoarthritis and is this uniform for

men and women?

3) Is the level of pain and mobility experienced by

adults with disabling hip joint osteoarthritis influenced

by body mass and/or the presence of one or more pre-

existing medical cond itions?

4) Is the level of pain and reduced mobility experi-

enced by adults with disabling hip joint osteoarthritis

influenced by the presence of muscle weakness as esti-

mated on a numeric scale?

2. MATERIALS AND METHODS

All available medical records of community-dwelling

adults hospitalized for hip replacement due to clinically

and radiographically diagnosed end-stage hip osteoar-

thritis of one or both hips were examined. These data

had been collected prospectively over a 10 month period

as part of an approved parent study of hip joint surgical

outcomes, but with no active patient involvement. Pa-

tients with acute hip fractures or any other primary di-

agnosis wer e excluded.

2.1. Study Sample

The cohort examined included 1040 men and women

between the ages of 23-89 years diagnosed as having

definitive clinical and radiographic evidence of os-

teoarthritis of one or both hip joints req uiring primary or

secondary surgery as determined by an orthopedic sur-

geon. The majority came from the local community.

2.2. Procedures

The desired data were systematically extracted by the

researcher from the patient’s medical record. These data,

which had been systematically recorded by the attending

physician[s], nurse[s] and physical therapist, included

age, gender, self-reported height and weight. They also

included the primary reason for hospital admission, the

presence and nature of any pre-existing orthopedic

problems, comorbid physical and/or mental health con-

ditions other than hip disease, and symptomatic self-

reported baseline pain estimates on a 5-point ordinal

scale where 1 was minimal pain and 5 was maximal pain.

Muscle weakness of the affected limb as identified by a

composite of physical tests including manual muscle

tests of the knee and hip muscles rated from 5-1 (no

problem-severe loss of strength) and active hip flexion

joint range of motion estimates of the affected hip (in

degrees), plus patient perceived pre-operative walking

status and distance in blocks and 3-day post-operative

walking distance as recorded in meters by the physical

therapist were also recorded. Separate calculations on

the chart included those of body mass index (weight/

height2) and ideal weight estimates (calculated for each

individual based on gender, age, height, and weight from

standard estimates that represent average medically

recommended values) and expressed as a percentage of

the patient’s actual body weight. Also recorded was the

disease duration, as well as presence of any other af-

fected joints and prior surgeries. The data were entered

systematically onto an Excel spreadsheet and transposed

thereafter, into SPSS version 16.0 files to describe the

sample and to analyze the data with regard to age (above

and below 60 years of age), gender, comorbid health

numbers, and pain and functional variables among the

observed hip osteoarthritis surgical candidates using

chi-square tests, cross-tabulations, and analysis of vari-

ance, as indicated. An a priori significance level of 0.05

was adopted.

3. RESULTS

3.1. General features

The 1040 cases presently studied had a mean age of

65.36 ± 13.04 years, with a median age of 68 years, and

a mode of 71 years. A s shown in Table 1, approximately

30% or 312 were 60 years or under in age. The number

hospitalized for primary unilateral surgery was 808 or

approximately 78%, 53 or 5% required bilateral surgery,

and 179 or 17.2% were undergoing revision surgery.

Overall, the present sample was constituted by more

females than males (60% vs 40%), but among cases un-

der the age of 60, the numbers of hospitalized men and

women were comparable (158 vs 163). Among this co-

hort, there were 9 reported comorbid health domains

related to different body systems as outlined by Dyke et

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698

al. [1], excluding obesity, including those shown in Ta-

ble 2. The frequency of patients having reported either a

mental or physical pre-existing health condition ranged

from 0 or no co-existing problem to 5, with a mean of 1

± 1, and a median of 1; 36% had no comorbid conditions,

30.5% had 1 condition, 22.9% had 2 conditions, 6.7%

had 3 conditions, 1.2% had 4 health conditions, and

0.2% had 5 co-existing conditions. The majority or

69.5% of cases had at least one additional pre-existing

physical health condition and the numbers of reported

comorbid health conditions increased with age (r = 0.232;

p = 0.001). That is, those who were 60 years and older

had more evidence of the presence of one or more ch-

ronic health conditions than those below 60 years of age.

When analyzed separately with regard to gender, on

average, women tended to slightly more comorbid con-

ditions than men (CIs being 1.06-1.22; 0.83-1.00, re-

spectively), although the median of 1, and range 0-5

were comparable (X2 = 18.61; df = 15; p = 0.232). In ad-

dition to the high prevalence of having at least one

co-existing physical problem, 52.7% of the cohort stud-

ied had a pre-existing orthopaedic problem such as a

fracture, or congenital bone problem, and in contrast to

medical comorbidity prevalence, men had higher rates of

co-existing orthopaedic related problems than women

(X2 = 9.98; df = 9; p = 0.001). Women had higher rates

of autoimmune diagnoses related to arthritis (X2 = 9.42;

df = 9; p = 0.001), and cardiac disease including hyper-

tension, heart murmurs and defective valve conditions

were observed most commonly among the diseases

listed on the charts.

In comparing those requiring bilateral hip surgery

with those hospitalized for primary unilateral surgeries,

these patients were found to be younger on average with

a mean age of 54.11 ± 13.18 years versus a mean age of

66.03 ± 12.4 years. Their comorbidity level was also

Table 1. Summary of key baseline demographic and disease related characteristics of the hip osteoarthritis cohort.

Values are means and standard deviations and percentages of total sample.

Characteristics Overall Group N = 1037Women N = 600 Men N = 437

Demographics

Age (years) 65.36 ± 13 67.22 ± 12.96 62.74 ± 12.70*

# under 60 yrs 316 (30.4%) 153 163

# over 60 yrs 723 447 274*

Body mass index (kg.m-2) 27.5 ± 5.7 26.6 ± 5.9 28.7 ± 5.1*

Morbidity Count 1.0 ± 1.0 1.2 ± 0.04 0.92 ± 0.04*

(Range 0-5)

0 37% 19% 17.5%

1 31.2% 18.9% 12.3%

2 23.4% 13.5% 9.9%

3 6.8% 5.1% 1.7%

4 1.3% 1.2% 0.2%

5 0.2% 0.1% 0.2%

Concomitant orthopedic problem 52% 25.2% 34%*

Autoimmune related diagnosis 5.6% 4.5% 2.2%*

Depression history 6.4% 5% 1.4%*

*men were significantly younger than women admitted for the same surgery p = 0.001

*fewer men over 60 yr s were admitte d th an w omen in present cohort p = 0.001

*men had fewer reported com orbid conditions (p = 0.002)

*men had higher body mass indices in general than the women, as well as more orthopedic problems than women p = 0.001

*men had fewer autoimmune and depression history related diagnoses than women p = 0.001

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Table 2. Summary of extent of comorbid diseases noted on

charts at baseline among hip osteoarthritis surgical cases when

disaggregated by gender showing significant gender differ-

ences (N = 560).

GENDER

Comorbid condition Female N (%) Male N (%)

Cardiovascular disease 187 (33%) 124 (22%)

Hypothyroidism 47 (8.3%) 5 (0.76%)

Osteoporosis 46 (8.8%) 1 (1.8)

Cancer 36 (6.4%) 22 (3.9%)

Depression 28 (5%) 8 (1.3%)

Autoimmune disease 28.5 (5%) 13 (2.3%)

Diabetes 20 (3.5%) 13 (2.3%)

Asthma 16 (3.9%) 20 (2.8%)

Stroke 5 (0.75%) 0

Kidney disease 4 (0.71%) 0

Prior injury/bone defect 98 (17.5%) 91 (16.2%)

Note: Some cases have more than one comorbid disease.

No records of visual or hearing impairme nts were available.

Cardiovascular disease category includes high blood pressure, or any

pre-existing heart condition or vascular disease.

lower than those undergoing unilateral surgery (p =

0.001), and was independent of age, when assessed us-

ing cross tabulations. It was thus deemed of interest to

specifically examine only those undergoing unilateral

surgery, as it was felt, those with bilateral hip joint os-

teoarthritis may have had a different health profile, in

general from the majority of the primary surgical cases.

Those hospitalized for a previous procedure, revision or

re-operation were also excluded.

3.2 Related Subgroup Analyses

In a further analysis of the 808 cases undergoing primary

unilateral surgery, median age, 68 years, it was observed

that this sub-group had one co morbid health problem on

average and the majority of these cases or 69.2% were

overweight or obese with a mean body mass index of

27.6 ± 5.5. Among those unilateral cases with comorbid

health conditions, the most common condition observed

was hypertension alone, or in combination with coronary

artery or cardiac disease. Next, injuries, bone disease or

prior surgeries were reported most often. The other con-

ditions were hypothyroidism, osteoporosis, and cancer.

Women had higher rates of all conditions except asthma

and stroke, and lower rates of prior injury than men.

To better control for potential confounders, a further

sub-analysis of 100 age-matched cases, mean age 66.3 ±

10.3 years (66 .52 ± 10 .98 year s of age for the 46 w omen;

66.06 ± 9.69 years of age for the 54 men, p = 0.822),

with comparable body mass indices of 27.7 and 27 .9, f or

women and men, respectively (p = 0.432), and an aver-

age of 1.2 comorb id conditions was undertaken as shown

in Ta ble 3. Again, this analysis revealed the subjective

pain levels experienced before surgery were found to be

significantly higher among the women compared to the

men (3.2 ± 0.84 versus 2.7 ± 0.9 on a 5 point Likert

scale, respectively) (p = 0.004 ), even though numbers of

affected joints were comparable (p = 0.125). As well,

men in the cohort tended to be able to walk further on

average than women before surgery, as well as three

days after surgery (p = 0.011; p = 0.018, respectively).

While these differences could not be explained on the

basis of comorbity numbers or body mass index (w.h-2)

because comorbidity rates were comparable, and a simi-

lar percentage were overweight or obese (48% men vs

50% women), the ideal body weights estimates calcu-

lated for women w ere 134 percent (CI 113-155) and 106

percent (CI 89-123) for men (p = 0.002) with a mean of

124.8 + 25.3 for the group. There was also a significant

inverse relationship between the ideal weight estimates

and the ability to walk one d ay after surgery (r = –0.246,

p = 0.043), but post surgical walking distance was not

affected by age, pain, comorbid status or body mass. On

the whole, weakness of the lower leg was evident in

40% cases, and of these cases, 7% had weakness of both

the hip and knee muscles. Although walking endurance

at baseline was generally worse if the kn ee ex ten sors and

or the hip and knee extensors on the operative side were

found to be weak, this was not significant (p = 0.196).

More subjects however, used devices to help them walk

if they reported weakness of the lower leg (p = 0.009),

and a higher percentage of women exhibited a lower leg

strength loss than men (61% vs 34%). Although the co-

hort were clearly challenged physically speaking, and

disease histories extended from 1 year to 18 years, pain

levels were not influenced by disease duration and only

5% women and 1.3% men had depression histories.

Walking distance and stair walking was affected by

numbers of affected joints, but was independent of muscle

strength. Device use was correlated positively with age.

4. DISCUSSION

Hip joint osteoarthritis, a debilitating condition that in-

creases in prevalence with age, presents an enormous

challenge to the health care system worldwide due to its

chronicity. To improve the outcomes for this group of

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Table 3. Table showing relationships between gender and walking capacity before and after surgery when controlling for pain in a

sub-group of cases older than 60 years of age (N = 100).

Gender Age Yr Walk Dist Blocks Comorbid NumberDay 3 walk dist FeetBMI w.h-2 Ideal wt Percent

F N = 46 66.5 ± 10.9 2.71 ± 2.89 1.11 ± 0.89 4.95 ± 43.1 5 27.2 ± 5.2 132.8 ± 25.3

M N = 54 66.1 ± 9.7 4.61 ± 3. 9* * 1 .24 ± 0.8 88.78 ± 43* 27.9 ± 4.2 118.6 ± 18.7**

** correlation is significant at 0.01 level (2- t ai led)

* correlation is significant at the 0.0 5 level (2-tailed)

adults, careful evaluation of the underlying pathophysi-

ological and contributing factors to the disease has be-

come essential. To this end, this present retrospective

analysis examined trends and interrelationships that

might exist among selected physical and health related

correlates of the condition and patient characteristics

believed to impact on osteoarthritis disability. In par-

ticular, a better understanding of mediating, moderating,

or causative factors such as gender, body mass, comor-

bid health status, and muscle weakness and the clinical

parameters of pain and functional disability was sought.

The goal was to identify new perspectives or to further

support current perspectives about what may be most

appropriate for purposes of reducing the disability and

handicap of hip joint osteoarthritis.

To this end, patients with symptomatic end-stage hip

osteoarthritis, and well defined radiological progression

were selected for study as there has been no universal

agreement as to what stage of progression might be

highly important to ex amine in the context of the natural

history of the disease, and which has been poorly evalu-

ated in the past [8]. All had well defined clinical as well

as functional disability that had progressed towards its

end stage, and the present study examined the variation

in disease presentation as regards health status, gender,

functional ability and pain among other factors to im-

prove our understanding of this condition. Patient sub-

sets were identified and examined to ascertain if any

would be more affected clinically by the disease than

others, and if so, if these displayed any unique physical

and health status characteristics.

While the current retrospective chart review ap-

proach can be seen as limitation, this exploratory study

tried to include the entire population of patients with

active disease who were admitted for primary or second-

dary hip surgery over a 10 month period and examined

their short-term functional recovery rates post-surgery.

Although it is recognized that the p resent findings could

be biased by who was studied, the age range of the stud-

ied cohort was quite typical of those described in the

literature [7,9] and consistent with several other studies

[7,10], a high percentage were women. As well, a high

majority of the cases presently reviewed reported having

at least one co-existing comorbid physical health condi-

tion, a finding identified by Van Dijk et al. [2] for adults

with osteoarthritis of the hip and knee. Moreover, con-

sistent with findings by Tuminen et al. [9], those older

than 60 years of age had significantly higher comorbidity

rates than those under 60 years of age (See Table 4).

In addition, although contrary to findings of Franklin

et al. [11] in an Icelandic case control study, a consis-

tently high percentage of the study cohort were over-

weight or obese as was observed by Dijk et al. [2].

While obesity can be regarded as a comorbid health

condition in its own right [2,8], th is health indicator was

presently analyzed separately from the other reported

comorbid health conditions, along with estimates of the

subject’s ideal body weight estimates expressed as a

percentage. In this respect, more than two thirds of the

men and women presently studied were overweight or

obese and women had higher percentages of ideal weight

estimates than men when co ntrolling fo r age, bod y mass,

and comorbidity number, suggesting women with this

disease are more overweight in general than men, when

considering their height and age. In addition, there were

gender differences in pre-surgical pain levels and func-

tional mobility at baselin e and post-surgery, in favour of

the men, and different distributions of comorbid health

conditions between men and women.

The higher than desirable numbers of comorbid health

conditions, autoimmune conditions, and high body wei-

ghts especially among women, are important to note,

because, as has been observed in other studies, hip os-

teoarthritis is more frequently part of a polyarticular

disease, with greater symptomatic and structural severity

[7]. In addition, comorbid ity and high body mass are risk

factors for functional activ ity limitation s and pain [2,3,9]

and greater deterioration of hip joint disease [12]. Obe-

sity is also correlated with higher mortality rates [11]

and poorer health status. While the severity of the co-

morbidity was not studied, consistent with findings by

Van Dijk et al. [2] the most common coexisting disease

presently observed was heart disease or hypertension, a

health condition expected to influence both activity and

pain levels, as well as the outcomes of options for sur-

gery and rehabilitation.

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Table 4. Sample of past studies that support some of the present findings and the hypothetical disability model.

Authors Sample Key Findings

Jorring [13] 6321 cases of whic h

4.7% had hip OA In all age gr ou ps a bov e 6 0 h ip OA was twice as common in women as in men

The condition was more severe radiologically in women who more handicapped than men

Juahkoski et al. [14] 118 cases of hip OA Comorbidity (CM) number influenced pain/function

Juhakoski et al. [1 5] 840 cases hip OA Heavy manual labor + injury were predictive for hi p OA

Kadam et al. [16] 11375 OA cases CM for OA was extensive compared to controls

Non musculoskeletal conditions observed included obesity, heart disease, phlebitis

CM was not explained by age, gender or social class

Katz et al. [17] Patients undergoing hip Women had worse functional status than men surgery for hip OA

Maiilefert et al. [7] 508 patients with hip OA Hip OA in women is more frequently part of a polyarticular OA and displays greater symptomatic

and structural severity

Roseman et al. [18] 1250 OA patien ts Main predictor of disability included body mass

Impact of OA differed between ge nde rs

More women than men constituted the sample

Tepper et al. [19] 73 cases of hip OA Age/hip trauma were associated with hip OA in men

Obesity was associated with bilateral hip OA

Tuominen et al. [9] 893 patients 649 or 73% had CM, mean no. = 2

-At baseline health-related QOL was lower in those with CM

Van Dijk et al. [2] 288 elderly-hip/knee OA Almost all had at leas t comorbidity

CM was related to activity limitations/pain

Most common CM condition = cardi ac diseases

Overweight and obesity was common

Note: CM = comorbidity; OA = osteoarthritis; QOL = quality of life

In terms of gender, and as has been observed in other

studies, although men and women had an equal chance

of being included in the study, women clearly consti-

tuted the majority of those hospitalized over the study

period. Moreover, even though the prevalence of the

disease is probably similar among men and women [7],

consistent with findings of other studies [7] women of

comparable ages to men with similar health histories,

could not walk as far on average with the same cond itio n

either before or after surgery. These observations support

the view that being female may be an independent risk

factor for disabling hip osteoarthritis as outlined by

O’Connor [4] and the higher rates of endocrine/etabolic

diseases, as well as cardiac diseases among the women

may explain their performance-based activity limitation s

[1]. They may also suffer from higher rates of muscle

mass and strength losses due to one or more of these

health condition s, as well as high leve ls of fat infiltration

that might impact their ability to function physically as

they age [20]. Indeed, although the women and men

currently examined had comparable body mass indices,

women as a whole exhibited higher ideal body weight

estimates as well as higher rates of strength losses of the

affected lower leg that can limit performance [1]. They

also had highe r rates of reported dep ression and pain.

Men, on the other hand, were more likely to simply be

overweight, to have lower rates of comorbid disease

and-to have suffered a prior orthopaedic problem, sug-

gesting a somewhat different disease profile. They may

thus suffer less or have less widespread intercurrent dis-

eases and related impairments than women and are thus

more active functionally before surgery and able to re-

cover more rapidly after surgery, and in the present case

were generally younger than the women.

Alternately, the greater disability presently experi-

enced by women than men with the same diagnosis,

which has also been observed among knee arthroplasty

candidates [21], may indicate women who are candidates

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702

for hip joint replacement surgery should be preferen-

tially targeted before and after surgery to offset unwar-

ranted functional declines, and the possibility of devel-

oping further radiological damage, cardiac diseases and

others. The data also show considerable inter-individual

differences in disease presentation and suggest more

attention to classifying patients according to the presence

or absence of comorbidities and mechanical or biologi-

cal factors may influence the disease outcome as well as

body weight, pain and functional capacity quite favora-

bly [14,20-24 ].

Moreover, because untreated or poorly treated hip os-

teoarthritis may increase the risk for obesity, as well as

related medical conditions, more carefully designed

preventive and therapeutic strategies that focus on mus-

cle strengthening are clearly indicated. In addition, to

reduce the ra te of progression of the disease, and to help

the patient to function optimally, those with unrelenting

pain might be targeted for treatment early on [6,25]. The

higher rate of thyroid disorders, osteoporosis, and auto-

immune conditions experienced by the women in the

present analysis suggests additional targets for early in-

tervention as well to offset possible excessive tissue

damage and injury. As well, generic efforts to prevent

injuries such as falls, may be influential in minimizing

the hip osteoarthritis burden, as may more targeted ef-

forts to reduce occupational stresses at work thought to

lead to hip osteoarthritis [5,15].

However, it is recognized that the present cohort may

not represent all cases with condition; not all data were

available or complete; and chart reviews may not be

without limitations. Also, even though several comorbid

health problems and their frequency of occurrence were

recorded, their severity was not. Visual impairments as

well as hearing impairments were also not recorded for

the hip osteoarthritis cases were studied. These condi-

tions, and their prevalence and relationship to hip os-

teoarthritis disability thus need to be studied further to

assess if concerted efforts to prevent and treat comorbid

conditions, as well as depression and pain may lessen the

disability associated with hip joint osteoarthritis and its

negative impact on functional independence and life

quality.

In summary, factors placing adults at risk for hip os-

teoarthritis disability are age, being female [10], having

high body weights [11], and one or more comorbid

health conditions. Muscle strength loss, trauma, exces-

sive loading of the hip joint as well as congenital hip

problems may also place individuals at risk for hip os-

teoarthritis as well high rates of further disability. Be-

cause over a third of the present cases were under 60

years of age, and had not necessarily experienced trauma,

but were heavier on average than those over age 60 years,

early and carefully tailored interventions to maximize

weight control seems highly desirable. Moreover, given

that being obese increases the risk for hip osteoarthritis

2.47 fold among women [26], women might be prefer-

entially targeted. In addition, professionals interested in

improving the outlook for adults with hip joint os-

teoarthritis must acknowledge the broad spectrum of

other health problems adults with hip osteoarthritis may

face that can impact the need for hip joint replacement

[23] as well as postoperative recovery processes [12,27]

and the true burd en of the disease [28]. In light of its im-

Hip osteoarthritis pathology and

severity

High ideal

weights

Comorbidity type and

number

Gender

Extent of health,

autoimmune,

orthopedic, problems

Extent leg

muscle weakness

Number of

diseased joi nts

and severity of

condition

Degree radiologica l damage

Figure 1. Hypothetical interaction of key variables other than age that might influence outcome of

ip osteoarthritis. h

R. Marks / HEALTH 2 (2010) 696-704

703

mense variability, and disproportionate impact on women,

a comprehensive rather than a uniform clinical pathway

for intervening in the hip osteoarthritis degenerative

process as advocated by Wang et al. [24] is indicated. In

particular, in addition to targeted efforts to assist with

weight maintenance or reduction and pain and depress-

sion control, the efficacy of implant and rehabilitation

tailoring should be explored. Assessing comorbidities

and the extent and severity of these at baseline may also

help to prioritize medical-decision making [9,26] and to

thereby tailor care appro aches that can po tentially redu ce

hospital stays, as well as the human and economic im-

pact [13,16-19,25,29].

REFERENCES

[1] Van Dijk, G.M., Veenhof, C., Lankhorst, G.J. and Dekker,

J. (2009) Limitations in patients with osteoarthritis of the

hip and knee: The relationship with body functions, co-

morbidity and cognitive function. Disability and Reha-

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