Background/Purpose:

Low birth weight and preterm birth have been associated with adverse adult outcomes including hypertension, insulin resistance, cardiovascular disease and reduced bone mass. It is unknown whether low birth weight and preterm birth affect the risk of osteoarthritis (OA). This study aims to examine whether low birth weight and preterm birth were associated with the incidence of knee and hip arthroplasty for OA.

Methods:

3,604 participants of the Australian Diabetes, Obesity and Lifestyle Study – a population-based, national prospective cohort study who reported their birth weight and history of preterm birth and were aged more than 40 years at the commencement of arthroplasty data collection. The incidence of knee or hip arthroplasty for OA during 2002-2011 was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazard regression models were used to estimate the hazard ratios (HR) and 95% confidence interval (CI) for knee or hip arthroplasty due to OA associated with low birth weight and preterm birth. Follow-up for arthroplasty (i.e. calculation of person-time) began in January 1, 2002, and ended at the date of first arthroplasty for OA or date of censoring. Each analysis was adjusted for age, sex, and body mass index (BMI), in model 1, as these are established risk factors for arthroplasty for OA. In model 2, the analyses were further adjusted for hypertension, diabetes, smoking status and physical activity. To test whether associations of low birth weight and preterm birth with arthroplasty risk were modified by obesity (BMI ≥ 30 kg/m²) and sex, interactions were fitted, and tested using the likelihood ratio test.

Results:

One hundred and sixteen participants underwent knee arthroplasty and 75 underwent hip arthroplasty for OA. Low birth weight (yes vs. no, HR 2.04, 95% CI 1.11-3.75, p=0.02) and preterm birth (yes vs. no, HR 2.50, 95% CI 1.29-4.87, p=0.007) were associated with increased incidence of hip arthroplasty independent of age, sex, BMI, education level, hypertension, diabetes, smoking and physical activity. No significant association was observed for knee arthroplasty. 

Conclusion:

Although these findings will need to be confirmed, they suggest that individuals born with low birth weight or preterm are at increased risk of hip arthroplasty for OA in adult life. The underlying mechanisms warrant further investigation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-low-birth-weight-and-preterm-birth-with-the-incidence-of-knee-and-hip-arthroplasty-for-osteoarthritis/