Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
Department of Orthopedics, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
Arthritis Res Ther. 2019 Aug 23;21(1):192. doi: 10.1186/s13075-019-1969-9.
BACKGROUND: Predicting which patients with hip osteoarthritis are more likely to show disease progression is important for healthcare professionals. Therefore, the aim of this review was to assess which factors are predictive of progression in patients with hip osteoarthritis. METHODS: A literature search was made up until 14 March 2019. Included were cohort and case-control studies evaluating the association between factors and progression (either clinical, radiological, or THR). Excluded were studies with a follow-up < 1 year or specific underlying pathologies of osteoarthritis. Risk of bias was assessed using the QUIPS tool. A best-evidence synthesis was conducted. RESULTS: We included 57 articles describing 154 different factors. Of these, a best-evidence synthesis was possible for 103 factors, separately for clinical and radiological progression, and progression to total hip replacement. We found strong evidence for more clinical progression in patients with comorbidity and more progression to total hip replacement for a higher Kellgren and Lawrence grade, superior or (supero) lateral femoral head migration, and subchondral sclerosis. Strong evidence for no association was found regarding clinical progression for gender, social support, pain medication, quality of life, and limited range of motion of internal rotation or external rotation. Also, strong evidence for no association was found regarding radiological progression for the markers CTX-I, COMP, NTX-I, PINP, and PIIINP and regarding progression to total hip replacement for body mass index. CONCLUSION: Strong evidence suggested that 4 factors were predictive of progression of hip osteoarthritis, whereas 12 factors were not predictive of progression. Evidence for most of the reported factors was either limited or conflicting. PROTOCOL REGISTRATION: PROSPERO, CRD42015010757.
背景:预测哪些髋骨关节炎患者更有可能出现疾病进展对于医疗保健专业人员很重要。因此,本综述的目的是评估哪些因素可预测髋骨关节炎患者的进展。
方法:我们进行了截至 2019 年 3 月 14 日的文献检索。纳入了评估因素与进展(临床、影像学或 THR)之间关联的队列研究和病例对照研究。排除了随访时间<1 年或特定骨关节炎潜在病理学的研究。使用 QUIPS 工具评估偏倚风险。进行了最佳证据综合。
结果:我们纳入了 57 篇描述了 154 种不同因素的文章。其中,有 103 种因素可进行最佳证据综合,分别针对临床和影像学进展以及进展为全髋关节置换术。我们发现,患有合并症的患者有更多的临床进展,Kellgren 和 Lawrence 分级更高、股骨头外侧或(supero)迁移程度更高、软骨下硬化程度更高,进展为全髋关节置换术的可能性更大。对于性别、社会支持、止痛药物、生活质量和内旋或外旋活动范围受限与临床进展之间的关联,我们发现没有强有力的证据。同样,CTX-I、COMP、NTX-I、PINP 和 PIIINP 等影像学进展标志物以及体重指数与全髋关节置换术进展之间的关联,也没有强有力的证据。
结论:有强有力的证据表明,4 个因素可预测髋骨关节炎的进展,而 12 个因素与进展无关。大多数报告的因素的证据要么有限,要么相互矛盾。
注册协议:PROSPERO,CRD42015010757。
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