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a Department
of Orthopaedic Surgery, University of Ulm, Ulm, Germany, b Department of Epidemiology,
University of Ulm, Ulm, Germany
Correspondence to: Dr K P Guenther, Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
Accepted for publication 16 September 1998
OBJECTIVES
Different prevalences of generalised
osteoarthritis (GOA) in patients with knee and hip OA have been
reported. The aim of this investigation was to evaluate radiographic
and clinical patterns of disease in a hospital based population of
patient subgroups with advanced hip and knee OA and to compare the
prevalence of GOA in patients with hip or knee OA, taking potential
confounding factors into account.
METHODS
420 patients with hip OA and 389 patients
with knee OA scheduled for unilateral total joint replacement in four
hospitals underwent radiographic analysis of ipsilateral and
contralateral hip or knee joint and both hands in addition to a
standardised interview and clinical examination. According to the
severity of radiographic changes in the contralateral joints (using
Kellgren-Lawrence
grade 2 as case definition) participants were
classified as having either unilateral or bilateral OA. If radiographic
changes of two joint groups of the hands (first carpometacarpal
joint and proximal/distal interphalangeal joints defined as two
separate joint groups) were present, patients were categorised as
having GOA.
RESULTS
Patients with hip OA were younger (mean
age 60.4 years) and less likely to be female (52.4%) than patients
with knee OA (66.3 years and 72.5% respectively). Intensity of pain
and functional impairment at hospital admission was similar in both
groups, while patients with knee OA had a longer symptom duration
(median 10 years) compared with patients with hip OA (5 years). In
41.7% of patients with hip OA and 33.4% of patients with knee OA an underlying pathological condition could be observed in the replaced joint, which allowed a classification as secondary OA. Some 82.1% of
patients with hip and 87.4% of patients with knee OA had radiographic changes in their contralateral joints (bilateral disease). The prevalence of GOA increased with age and was higher in female patients.
GOA was observed more often in patients with knee OA than in patients
with hip OA (34.9% versus 19.3%; OR=2.24; 95% CI: 1.56, 3.21).
Adjustment for the different age and sex distribution in both patient
groups, however, takes away most of the difference (OR=1.32; 95% CI:
0.89, 1.96).
CONCLUSION
The crude results confirm previous
reports as well as the clinical impression of GOA being more prevalent
in patients with advanced knee OA than in patients with advanced hip
OA. However, these different patterns might be attributed to a large
part to a different distribution of age and sex in these hospital based populations.
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