Prognosis of hip pain in general practice: A prospective followup study

Abstract

Objective Hip pain in the elderly is the main feature of osteoarthritis of the hip. In this prospective followup study, we wanted to determine which patients with hip pain show disease progression, and what the incidence of total hip replacement (THR) is in this group of patients after 3 and 6 years of followup. Methods Within general practices in the area of Rotterdam (The Netherlands), persons age ≥50 years with incident hip pain were included. After 3 and 6 years, progression of hip pain was assessed. Results A total of 224 patients were included. After 3 years disease progressed in 29 (15%) patients and 23 (12%) received a THR. After 6 years disease progressed in 45 (28%) patients and 36 (22%) received a THR. The prognostic variables for a THR after 3 and 6 years related to history taking were age ≥60 years, morning stiffness, and pain in the groin/medial thigh; variables related to physical examination were decreased extension/adduction, painful internal rotation, and a body mass index ≤30 kg/m²; and the variable related to radiologic findings was a Kellgren/Lawrence grade of 2 or higher. Conclusion In this study population, ∼12% of patients presenting with hip pain to their general practitioner will undergo a THR within 3 years, and ∼22% after 6 years. Using the variables obtained from history taking, physical examination, and radiologic findings enables better identification of persons at high risk for a THR.