Clinical study
Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors

https://doi.org/10.1016/S0002-9343(02)01447-XGet rights and content

Abstract

Purpose

We studied whether several modifiable factors were associated with the risk of total hip replacement due to hip osteoarthritis among women.

Methods

We identified 568 women from the Nurses’ Health Study who reported total hip replacement due to primary hip osteoarthritis on questionnaires from 1990 to 1996, using a validated algorithm. The relation of potential risk factors, such as age, body mass index, physical activity, smoking, alcohol intake, and hormone use, to hip replacement was assessed using pooled logistic regression models.

Results

Higher body mass index was associated with an increased risk of hip replacement due to osteoarthritis (P for trend = 0.0001). Compared with women in the lowest category of body mass index (<22 kg/m2), those in the highest category of body mass index (≥35 kg/m2) had a twofold increased risk (95% confidence interval [CI]: 1.4 to 2.8), whereas those in the highest category of body mass index at age 18 years had more than a fivefold increased risk (95% CI: 2.5 to 10.7). Age also had a positive association; women aged ≥70 years were nine times more likely to have hip replacement than those aged <55 years (95% CI: 5.4 to 13.9). Recreational physical activity, smoking, alcohol use, and postmenopausal hormone use were not associated with an increased risk of hip replacement.

Conclusion

In the Nurses’ Health Study, higher body mass index and older age significantly increased the risk of total hip replacement due to osteoarthritis. Part of this risk appeared to be established early in life.

Section snippets

Methods

The Nurses’ Health Study is a prospective cohort of 121,701 female nurses who were aged 30 to 55 years in 1976. Information on diseases, lifestyle, and health practices is collected from the subjects via biennial questionnaires, with a response rate of greater than 90% for each questionnaire.

We used self-reported total hip replacement on the 1990 to 1996 questionnaires as a surrogate for clinically severe primary hip osteoarthritis. We mailed a supplementary questionnaire to all participants

Results

Of the 1435 women who reported hip replacement from 1990 to 1996, 1142 (80%) responded to the supplemental questionnaire to confirm the diagnosis of primary osteoarthritis. Of these, 871 women (76%) reported hip replacement due to osteoarthritis. We excluded 137 women who had surgery before 1990 and 166 who had cancer or cardiovascular disease, leaving 568 cases for analysis.

Women with higher body mass index were less likely to take postmenopausal hormones, exercise, drink alcohol, or smoke

Discussion

In a cohort of more than 93,000 female nurses, we found that high body mass index was a risk factor for total hip replacement due to osteoarthritis. In addition, a substantial risk associated with body mass index was established early in life; even modest increments in body mass index at age 18 years were associated with a greater risk of future hip replacement. Unlike some studies 17, 20, 26, 27, 28, 29, 30, we found no association between hip replacement due to osteoarthritis and

Acknowledgements

We wish to thank the dedicated nurses in the Nurses’ Health Study who have now participated in the study for more than 25 years. We also thank Julie Herbstman for her assistance, Drs. Piran Aliabadi and John Carrino for reviewing the radiographs, and Dr. Jeffrey Katz for reviewing the manuscript.

References (38)

  • D.T. Felson et al.

    Risk factors for incident radiographic knee osteoarthritis in the elderlythe Framingham Study

    Arthritis Rheum

    (1997)
  • D.J. Hart et al.

    Incidence and risk factors for radiographic knee osteoarthritis in middle-aged womenthe Chingford Study

    Arthritis Rheum

    (1999)
  • S.A. Oliveria et al.

    Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee

    Epidemiology

    (1999)
  • J.L. van Saase et al.

    Osteoarthritis and obesity in the general population. A relationship calling for an explanation

    J Rheumatol

    (1988)
  • E. Vingard

    Overweight predisposes to coxarthrosis. Body-mass index studied in 239 males with hip arthroplasty

    Acta Orthop Scand

    (1991)
  • S. Tepper et al.

    Factors associated with hip osteoarthritisdata from the First National Health and Nutrition Examination Survey (NHANES-I)

    Am J Epidemiol

    (1993)
  • M. Heliovaara et al.

    Association of overweight, trauma and workload with coxarthrosis. A health survey of 7,217 persons

    Acta Orthop Scand

    (1993)
  • K.E. Roach et al.

    Biomechanical aspects of occupation and osteoarthritis of the hipa case-control study

    J Rheumatol

    (1994)
  • E. Vingard et al.

    Lifestyle factors and hip arthrosis. A case referent study of body mass index, smoking and hormone therapy in 503 Swedish women

    Acta Orthop Scand

    (1997)
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    Supported by grants AR42630, CA87969, AR36308, and K08 AR 02074-1 from the National Institutes of Health, Bethesda, Maryland. Dr. Karlson is the recipient of an Arthritis Foundation Investigator Award. Dr. Mandl is a recipient of an Arthritis Foundation Physician Scientist Award.

    Deceased. Formerly from the University of Munich, School of Medicine.

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