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Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors

  • Elizabeth W Karlson
    Correspondence
    Requests for reprints should be addressed to Elizabeth W. Karlson, MD, 75 Francis Street, Boston, Massachusetts 02115, USA
    Affiliations
    Division of Rheumatology, Immunology, and Allergy, Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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  • Lisa A Mandl
    Affiliations
    Division of Rheumatology, Immunology, and Allergy, Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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  • Gideon N Aweh
    Affiliations
    Division of Rheumatology, Immunology, and Allergy, Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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  • Oliver Sangha
    Footnotes
    Affiliations
    Division of Rheumatology, Immunology, and Allergy, Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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  • Matthew H Liang
    Affiliations
    Division of Rheumatology, Immunology, and Allergy, Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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  • Francine Grodstein
    Affiliations
    Division of Rheumatology, Immunology, and Allergy, Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Author Footnotes
    † Deceased. Formerly from the University of Munich, School of Medicine.

      Abstract

      Purpose

      We studied whether several modifiable factors were associated with the risk of total hip replacement due to hip osteoarthritis among women.

      Methods

      We identified 568 women from the Nurses’ Health Study who reported total hip replacement due to primary hip osteoarthritis on questionnaires from 1990 to 1996, using a validated algorithm. The relation of potential risk factors, such as age, body mass index, physical activity, smoking, alcohol intake, and hormone use, to hip replacement was assessed using pooled logistic regression models.

      Results

      Higher body mass index was associated with an increased risk of hip replacement due to osteoarthritis (P for trend = 0.0001). Compared with women in the lowest category of body mass index (<22 kg/m2), those in the highest category of body mass index (≥35 kg/m2) had a twofold increased risk (95% confidence interval [CI]: 1.4 to 2.8), whereas those in the highest category of body mass index at age 18 years had more than a fivefold increased risk (95% CI: 2.5 to 10.7). Age also had a positive association; women aged ≥70 years were nine times more likely to have hip replacement than those aged <55 years (95% CI: 5.4 to 13.9). Recreational physical activity, smoking, alcohol use, and postmenopausal hormone use were not associated with an increased risk of hip replacement.

      Conclusion

      In the Nurses’ Health Study, higher body mass index and older age significantly increased the risk of total hip replacement due to osteoarthritis. Part of this risk appeared to be established early in life.
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