The Role of Hip Injury in Pain Exacerbation in Hip Osteoarthritis: an Internet-Based Case-Crossover Study

Kai Fu¹, Joanna Makovey², Ben Metcalf³, Kim Bennell³, Yuqing Zhang⁴, Rebecca Asher⁵, Sarah Meneses², Leticia Deveza² and David Hunter², ¹Rheumatology, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Syndey, Australia, ²Rheumatology, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia, ³Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia, ⁴School Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, ⁵NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Hip, internet, osteoarthritis and pain

Session Information

Date: Tuesday, November 7, 2017

Title: Osteoarthritis – Clinical Aspects Poster II: Observational and Epidemiological Studies

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Pain is the main symptom in hip osteoarthritis (OA) and many patients experience recurrent pain exacerbations. The purpose of this study is to evaluate the association between hip injury and hip pain exacerbations in persons with symptomatic hip OA.

Methods: We conducted an internet-based case-crossover study to assess potential risk factors, including hip injury, for hip pain exacerbation. Eligible participants with symptomatic hip OA were followed for 90 days and asked to complete online questionnaires at 10-day intervals (control periods). They also logged on to the study website to complete questionnaires in the episode of a hip pain exacerbation (case periods) defined as an increase of 2 points in pain intensity compared with baseline on numeric rating scale (0-10). Participants were asked whether they had hip injury that limited usual activities (such as falls, sports injuries, etc.) during the last 7 days and whether they experienced any episodes of hip “giving way” in the last 2 days at both control and case periods. The relationship of hip injury and “giving way” to the risk of pain exacerbation was examined using conditional logistic regression.

Results: Of 249 patients recruited 133 (53%) and 132 (53%) with both control periods and case periods were included in the analysis of injury and “giving way” respectively. Hip injury during the last 7 days increased the risk of pain exacerbations (odds ratio [OR] 2.74, 95% CI 1.62, 4.62) compared with no injury to the hip. Hip “giving way” during the last 2 days was also associated with an increased risk of hip pain exacerbation (OR 2.50, 95% CI 1.68, 3.73), and showed a significant dose-response relationship between the number of hip “giving way” events and risk of hip pain exacerbations during the last 2 days (≥ 6 vs. 0 episodes; OR 7.86, 95% CI 2.74, 22.55).

Conclusion: The findings of this study indicate that hip injury and episodes of hip “giving way” are significantly related to pain exacerbation in persons with symptomatic hip OA. Reducing and avoiding such episodes may decrease the risk of hip pain exacerbations and improve the pain situation in persons with hip OA.

Tables

Table 1. Association of hip injury and hip pain exacerbation (132 subjects)

Hip injury

Case periods

(n=304)

Control periods

(n=807)

OR (95% CI)

P-value

Yes

253 (83%)

51 (17%)

760 (94%)

47 (6%)

–

2.74 (1.62, 4.62)

–

<0.001

Table 2. Association of hip “giving way” and hip pain exacerbation (133 subjects)

Hip “giving way”

Case periods

(n=347)

Control periods

(n=905)

OR (95% CI)

P-value

Yes

288 (83%)

59 (17%)

843 (93%)

62 (7%)

–

2.50 (1.68, 3.73)

–

<0.001

Table 3. Association of the number of hip “giving way” events and hip pain exacerbations

Number of hip “giving way” events in the past 2 days

Case periods (n=347)

Control periods (n=905)

OR (95% CI)

P-value

2-5

≥6

215 (62%)

43 (12%)

64 (18%)

25 (7%)

718 (79%)

87 (10%)

92 (10%)

8 (1%)

–

1.86 (1.14, 3.04)

4.53 (2.00, 5.75)

7.86 (2.74, 22.55)

–

<0.001

Disclosure: K. Fu, China Scholarship Council (CSC), 9; J. Makovey, None; B. Metcalf, None; K. Bennell, None; Y. Zhang, None; R. Asher, None; S. Meneses, None; L. Deveza, None; D. Hunter, Flexion, Merck Serono, Tissuegene, 5,DJO, 7.

To cite this abstract in AMA style:

Fu K, Makovey J, Metcalf B, Bennell K, Zhang Y, Asher R, Meneses S, Deveza L, Hunter D. The Role of Hip Injury in Pain Exacerbation in Hip Osteoarthritis: an Internet-Based Case-Crossover Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-role-of-hip-injury-in-pain-exacerbation-in-hip-osteoarthritis-an-internet-based-case-crossover-study/. Accessed .

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