Vol.2, No.7, 696-704 (2010)
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/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.
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
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
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
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?
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.
3.1. 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
R. Marks / HEALTH 2 (2010) 696-704
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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
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).
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.
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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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
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
High ideal
Comorbidity type and
Extent of health,
orthopedic, problems
Extent leg
muscle weakness
Number of
diseased joi nts
and severity of
Degree radiologica l damage
Figure 1. Hypothetical interaction of key variables other than age that might influence outcome of
ip osteoarthritis. h
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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].
[1] Van Dijk, G.M., Veenhof, C., Lankhorst, G.J. and Dekker,
J. (2009) Limitations in patients with osteoarthritis of the
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