Predictors of total hip replacement in community based older adults: a cohort study

Laura Laslett* (Corresponding Author), Harbeer G. Ahedi, Christopher Leigh Blizzard, Richard Aspden, Jenny Gregory, Fiona Saunders, Veronica Mezhov* (Corresponding Author), Ishanka Munugoda, Guoqi Cai, Flavia M. Cicuttini, Stephen Graves, Michelle Lorimer, Graeme Jones

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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The purpose of this study is to describe predictors of total hip replacement (THR) in community dwelling older adults. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. At baseline, participants had assessment of radiographic OA and cam morphology (from pelvic radiographs), shape mode scores and hip bone mineral density (BMD; from dual energy X-ray absorptiometry (DXA)). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression. Incidence of THR for OA over 14 years was 4.6% (37/801). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.83 per SD; 95% CI 1.1-3.04), shape mode 4 score (non-spherical femoral head) (RR 0.59/SD; 95% CI 0.36-0.96), cam morphology (α >60°) (RR 2.2/SD; 95% CI 1.33-3.36), neck of femur BMD (RR 2.09/SD, 95% CI 1.48-2.94) and bone marrow lesions (BMLs) increased risk of THR (RR 7.10/unit; 95% CI 1.09-46.29). In addition to hip pain and radiographic hip OA, measures of hip shape, cam morphology, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR. [Abstract copyright: Copyright © 2021. Published by Elsevier Ltd.]
Original languageEnglish
Pages (from-to)1130-1137
Number of pages8
JournalOsteoarthritis and Cartilage
Issue number8
Early online date7 May 2021
Publication statusPublished - Aug 2021

Bibliographical note

This work was supported by the National Health and Medical Research Council of Australia (NHMRC Grant ID – 302204); Tasmanian Community Fund (Grant ID – D0015018); Masonic Centenary Medical Research Foundation; Royal Hobart Hospital Research Foundation; Arthritis Foundation of Australia (Grant ID – MRI06161); and University of Tasmania institutional research grants scheme (D0015019). The study sponsor had no role in the design of the study; the collection, analysis, and interpretation of the data; or the writing of the article and the decision to submit it for publication. Laura Laslett is supported by a National Health and Medical Research Council of Australia Early Career Fellowship (1070586). Graeme Jones is supported by a NHMRC Practitioner Fellowship (1023222).


  • Hip osteoarthritis
  • Total hip replacement
  • Bone shape
  • Bone mineral density
  • Cam morphology
  • Bone marrow lesions
  • Predictors


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