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Hip Bone Marrow Lesions: Prevalence and Risk Factors in Asymptomatic and Osteoarthritic Adults

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19 diapositives · 326 Views · Jul 21, 2014

This research explores the prevalence and significance of hip bone marrow lesions (BMLs) in both asymptomatic and osteoarthritic adults. Conducted within the Melbourne Collaborative Cohort Study, it highlights the high prevalence of BMLs in an osteoarthritic population and identifies risk factors such as age and BMI. The study reveals associations between BMLs and hip joint structural changes, emphasizing their potential role as a target for treatment and prevention strategies in hip osteoarthritis.

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  1. Hip Bone Marrow Lesions in asymptomatic and osteoarthritic adults: Prevalence, risk factors and significance Summer Research Project Luke Dawson

  2. What is Hip OA • Loss of cartilage • Leading to pain and disability • No Curative treatment • Total Joint Replacement • Research • Most at knee, little at hip

  3. How are BMLs relevant to OA? BMLs PAIN OA Progression Total Knee Replacement Increased pain in OA sufferers Including: Cartilage Loss Cartilage Defects Joint Space Narrowing

  4. What is a BML? • Definition • Low signal intensity on T1 weighted MR images • High signal intensity on T2 weighted MR images • Subchondral • Histopathological Correlation • Substantial (Leydet-Quilici, 2010) • Edema, fibrosis, necrosis

  5. What are risk factors for BMLs? BMLs Metabolic Biomechanical BMI Fat Mass Lipids ↑Vitamin C reduces risk Smoking Trauma Misalignment

  6. Aims • BMLs at the knee joint well studied • BMLs at the hip joint not studied • Prevalence, associations • Asymptomatic, osteoarthritic

  7. Patients • Melbourne Collaborative Cohort Study • Prospective cohort study 1990-1994 • 142 participants recruited • Exclusion criteria • Hip OA, recent hip pain, malignancy, arthritis • 19 Hip OA participants also recruited • Box Hill MRI Centre

  8. Methods • Trained observer • BMLs • Present or absent • Kappa intra-observer reliability 0.73 • Also measured high-intensity BML • Previously Measured • Cartilage volumes (mm3) • Bone head area (mm2)

  9. Measurement of hip cartilage volume (mm3)

  10. Results I • Age • 66.8+/-7.4 years (healthy) • 59.5+/-7.6 years (OA) • p<0.001 • Females • 55.6% (healthy) • 57.9% (OA) • p=0.85 • BMI • 27.6+/-4.8 kg/m2 (healthy) • 27.2+/-4.8 kg/m2 (OA) • p=0.73

  11. Results II • Prevalence of BMLs at the Hip • 17.6% in asymptomatic population • 63.2% in OA population • Risk Factors for BMLs • Younger Age, p=0.045 in asymptomatic group • Not associated with gender or BMI

  12. Results III • BMLs and Osteoarthritis • OR 5.32, 95%CI 1.78-15.9, p=0.003 • Adjusted for age, gender, BMI • BMLs and lower Cartilage Volume • -245.7 mm3 (95%CI -455.5, -36.0, p=0.02) (total pop) • -426.6 mm3 (95%CI -855.2, 2.14, p=0.05) (OA group) • Adjusted for age, gender, BMI, bone area, hip OA

  13. Results IV • High Intensity BMLs • More strongly associated with OA • Location of lesions • Lower inner quadrant • Upper outer quadrant • Femoral acetabular impingement

  14. Discussion • BMLs common at hip joint in those with OA • Also present in asymptomatic • Associated with reduced hip cartilage volume • Comparable to knee BMLs • 17.6% (hip) v 13.1-14.9% (knee) in asymptomatic population • 63.2% (hip) vs 46.9-66% (knees) in OA group • Significantly associated with OA • Significantly associated with structural damage • Younger age is a risk factor • ?Low grade trauma

  15. Limitations • Cross-sectional • Need longitudinal data • Small sample size of OA group • Narrow Age Range • Effect of physical Activity

  16. Conclusions • BMLs are associated with hip OA • BMLs at hip may provide a novel target for the treatment and prevention of hip OA

  17. Thanks to • Rheumatology Research Team • FlaviaCicuttini, Yuanyuan Wang, Anita Wluka, Fahad Hanna • Summer Project Coordinators • JayaminiIllesinghe, BasiaDiug • SPHPM