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Table 3 Hand, hip and ankle structural associations by feature and quality grade

From: A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis

Author

Feature (method)

Structural severity or progression outcome

Adjustment for confounders

Association (magnitude) crude

Association (magnitude) adjusted

Association

Quality (score %)

Hand MRI bone marrow lesion case series

Haugen 2014 [141]

BMLs - semi-quantitative at 2nd to 5th IPJs (C)

Progression of hand ROA (JSN, KL grade or new erosion) (L)

Age, sex, BMI,

OR 2.73, 95 % CI 1.29 to 5.78

NR

+

High (61)

Bigger the BML, the more the JSN

Hand MRI bone marrow lesion cross-sectional studies

Haugen 2012 Abstract [143] 299

BML (Oslo MRI hand score) (C) IPJs

Radiographic JSN grade IPJ (OARSI atlas) (C)

Age, sex,

OR 10.0, 95 % CI 4.2 to 23

OR 4.4, 95 % CI 2.2 to 9.0

+

Low (43)

BML score association with more JSN

Haugen 2012 [142]

BML (Oslo MRI hand score) (C) IPJs

Hand KL grade of IPJs (C)

Age, sex

NR

OR (95 % CI)

+

High (64)

BMLs 11 (5.5 to 21)

p <0.001

Hand MRI osteophyte cross-sectional studies

Haugen 2012 [142]

Osteophyte (Oslo MRI hand score) (C) IPJs

Hand KL grade of IPJs (C)

Age, sex

NR

OR (95 % CI)

+

High (64)

osteophytes

415 (189 to 908)

p <0.001

Hand MRI attrition cross-sectional studies

Haugen 2012 [142]

Attrition (Oslo MRI hand score) (C) IPJs

Hand KL grade of IPJs (C)

Age, sex

NR

OR (95 % CI) attrition 87 (37 to 204)

+

High (64)

p <0.001

Hand MRI bone cyst cross-sectional studies

Haugen 2012 [142]

Cyst (Oslo MRI hand score) (C) IPJs

Hand KL grade of IPJs (C)

Age, sex

NR

OR (95 % CI)

Nil

High (64)

cysts 2.0 (0.6 to 6.3)

p = 0.26

Hip MRI BML cross-sectional studies

Neumann 2007 [46]

Semi-quantitative BMLs (C)

Semi-quantitative cartilage lesions (C)

Nil

R = 0.44, p ≤0.001

NR

+ Correlation between BML and cartilage lesions

Low (43)

Dawson 2013 Abstract [69]

Femoral head BMLs (MRI) (C)

1. Presence of hip OA. 2. Femoral head cartilage volume (MRI) (C)

Age, sex, BMI

NA

OA hip presence

+

Low (14)

BMLs associated with diagnosis of hip OA

OR (95 % CI)

5.32 (1.78 to 15.9)

p = 0.003

BMLs inversely associated with cartilage volume

cartilage volume

regression coefficient (95 % CI)

−245.7 mm3

(−456 to −36) p = 0.02

Hip CT bone morphometry cross-sectional studies

Chiba 2011 [33]

Acetabular and femoral head subchondral trabecular morphometry: bone volume fraction, trabecular thickness, number, separation (CT) (C)

Hip joint space volume (CT) (C)

Nil

Femoral head Bone volume fraction r = −0.691, p <0.001

NR

Joint space narrowing is associated with increased bone volume fraction, trabecular thickening. trabecular number and spacing decrease

Low (57)

Hip DXA BMD cross-sectional studies

Chaganti 2010 [30]

Femoral neck BMD (C) DXA

Hip ROA Modified Croft score (categorical 0–4) (C)

Age, BMI, height, activity level, race, 6-m walk pace, Nottingham muscle strength, inability to do chair stands, and clinic site,

NR

p <0.0001

+

High (64)

Higher BMD for higher grade of OA of hip

Antoniades 2000 [32]

DXA BMD of the femoral neck of left (nondominant) hip with ROA (C)

Radiographic OA (Croft score) (C)

BMI, lifetime physical activity, menopausal status, use of oestrogen, and smoking

OR 1.63, 95 % CI 1.06 to 2.50)

OR 1.80, 95 % CI 1.05 to 3.12

+ Association between BMD and hip ROA grade in the index hip

High (64)

Higher OA grade means higher BMD

2D Hip bone shape longitudinal studies

Agricola 2013 [146]

Baseline 2D femoral and acetabular shape modes (segmented by statistical shape modelling) (C)

THR at or within 5 years (L)

Age, sex, BMI, shape modes

5 modes were associated with THR OR 1.71 to 2.01, p ≤0.001

3 modes were associated with THR OR 1.78 to 2.10, p ≤0.001

+ Increasing femoral head asphericity is associated with THR

High (72)

Agricola 2013 [147]

Baseline alpha angle (2D femur shape) dichotomous abnormal >60 °, normal ≤60 ° (C)

Incident ROA hip (KL >1), incident end-stage ROA hip (KL >2 or THR) at or within 5 years (L)

Age, sex, BMI, KL grade

OR (95 % CI) Incident ROA hip 6.82 (3.55 to 13.10) p <0.0001

OR (95 % CI) incident ROA hip 2.42 (1.15 to 5.06) p = 0.02, incident severe ROA or THR 3.67 (1.68 to 8.01) p <0.0001

+ Elevated alpha angle is associated with incident end-stage OA hip

High (67)

Agricola 2013 [148]

Baseline 2D centre edge angle (acetabular shape): 25 ° <normal <40 °, undercoverage <25 °, overcoverage >40 ° (C)

Incidence within 5 years of: 1. ROA hip (KL >1), 2. end-stage OA (KL >2 or THR)

Age, sex, BMI, KL grade

OR (95 % CI) overcoverage 0.52 (0.19 to 1.43) p = 0.21, undercoverage 3.64 (1.91 to 6.99) p = 0.00

OR (95 % CI) overcoverage 0.34 (0.13 to 0.87) p = 0.025, undercoverage 5.45 (2.40 to 12.34) p = 0.00

Overcoverage is protective against OA incidence (−). Undercoverage is associated with greater odds of OA incidence and end-stage OA (+)

High (67)

2D and 3D hip bone shape cross-sectional studies

Gosvig 2010 [149]

Categorical hip 2D deformity: 1. normal, 2.‘pistol grip’, 3) deep acetabular socket (C)

Presence of radiographic hip OA (JSW ≤2 mm) (C)

Age, sex, BMI, other hip deformities

NR

RR (95 % CI) pistol grip 2.2 (1.7 to 2.8) p <0.001, deep acetabular socket 2.4 (2.0 to 2.9) p <0.001, normal (p >0.05)

+

Low (50)

Reichenbach 2011 [27]

The presence or absence of any 3D semi-quantitative MRI-defined cam-deformity (C)

Combined femoral and acetabular cartilage thickness (C)

Age, BMI (NB all participants were young men)

Unadjusted mean cartilage thickness difference with CAM deformity −0.24 mm (95 % CI −0.46 to −0.03)

Adjusted mean cartilage thickness difference with CAM deformity −0.19 mm (95 % CI −0.41 to 0.02)

NC

High (64)

2D hip bone shape case control studies

Doherty 2008 [43]

Non-spherical femoral head 2D shape assessment: 1. appearance of ‘pistol grip deformity’ (C), 2. maximum femoral head diameter ratio to minimum parallel femoral neck diameter (C)

Presence of radiographic hip OA (JSW ≤2.5 mm) (C)

Age, sex, BMI, BMD, physical activity, history of hip injury, type 3 hand (index finger shorter than ring finger), hand nodes, and center-edge angle

OR (95 % CI) pistol grip deformity 5.75 (4.00 to 8.27). Femoral head-to-neck ratio 10.45 (7.16 to 15.24)

OR (95 % CI) pistol grip deformity 6.95 (4.64 to 10.41). Femoral head-to-neck ratio 12.08 (8.05 to 18.15)

+

Low (53)

Barr 2012 [150]

2D Shape measures of centre-edge angle (acetabular shape) (C)

THR vs no radiographic progression over 5 years (L)

Age, gender, BMI KL grade, use of walking stick, WOMAC function, duration of pain

OR (95 % CI) mode 2 0.74 (0.50 to 1.10) p >0.05

OR (95 % CI) Mode 2 0.17 (0.04 to 0.71) p <0.05

NB, this model association is inverse and correlates with acetabular shape

High (76)

Nicholls 2011 [39]

CAM deformity; mean modified triangular index height, alpha angle. 2D acetabular dysplasia; mean lateral center edge angle, (C)

Total hip replacement (L)

BMI, age

OR (p value) triangular index 1.131 (0.021). Alpha angle 1.056 (<0.0005). Centre edge angle 0.906 (0.004)

OR (p value) Triangular index 1.291 (0.011). Alpha angle 1.057 (<0.0005). Centre- edge angle 0.887 (0.002)

+ Association of hip replacement with CAM impingement and acetabular dysplasia indicated by these results

High (71)

Ankle scintigraphic subchondral bone cross-sectional studies

Kraus 2013 [60]

Ipsilateral late phase bone scintigraphy, retention presence in tibiotalar joint (C)

Tibiotalar ROA KL grade and JSN (C)

Age, gender, BMI

NR

KL grade r = 0.49, p <0.0001. JSN r = 0.35, p <0.0001

+

High (71)

Knupp 2009 [24]

Late phase bone scintigraphy, semi-quantitative retention scoring of tibiotalar joint (C)

Tibiotalar ankle joint JSN. (modified Takakura score) (C)

Nil

0.62 to 0.75 (p <0.01)

NR

+

Low (57)

  1. Positive correlation was reported between bone feature and outcome measure (+); negative correlation reported between bone feature and outcome measure (−).BMD bone mineral density, BML bone marrow lesion, C a feature or outcome described in cross-section, CT computed tomography, DXA dual-energy x-ray absorptiometry, HOAMS Hip osteoarthritis MRI scoring system, IPJ interphalangeal joint, JSN joint space narrowing, JSW joint space width, KL Kellgren-Lawrence, L a feature or outcome described longitudinally, NA no association, NC no conclusion could be found for an association between bone feature and outcome measure, MRI magnetic resonance imaging, PFJ patellofemoral joint, ROA radiographic osteoarthritis, OA osteoarthritis, OARSI Osteoarthritis Research Society International, OR odds ratio, RR relative risk, TFJ tibiofemoral joint, THR total hip replacement, TKR total knee replacement, VAS visual analogue scale, WOMAC Western Ontario and McMaster Universities arthritis index, WORMS whole-organ magnetic resonance imaging score