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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