Systematic Review of the Prevalence of Radiographic Primary Hip Osteoarthritis

Symposium: Femoroacetabular Impingement: Current Status of Diagnosis and Treatment


Hip osteoarthritis is a common cause of musculoskeletal pain in older adults and may result in decreased mobility and quality of life. Although the presentation of hip osteoarthritis varies, surgical management is required when the disease is severe, longstanding, and unresponsive to nonoperative treatments. For stakeholders to plan for the expected increased demand for surgical procedures related to hip osteoarthritis, including arthroplasty, it is important to first understand its prevalence. We conducted a systematic review by searching MEDLINE® and EMBASE to identify recent English language articles reporting on the prevalence of radiographic primary hip osteoarthritis in the general adult population; references including studies and primary studies from previous systematic reviews were also searched. This strategy yielded 23 studies reporting 39 estimates of overall prevalence ranging from 0.9% to 27% with a mean of 8.0% and a standard deviation of 7.0%. Heterogeneity was noted in study populations, eligibility criteria, age and gender distribution, type of radiographs, and method of diagnosis. Although the association between radiographic hip osteoarthritis and the need for eventual surgical management is still unclear, this study supports assertions that hip osteoarthritis is a prevalent condition whose treatment will continue to place important demands on health services.


  1. 1.
    Andrianakos AA, Kontelis LK, Karamitsos DG, Aslanidis SI, Georgountzos AI, Kaziolas GO, Pantelidou KV, Vafiadou EV, Dantis PC, ESORDIG Study Group. Prevalence of symptomatic knee, hand, and hip osteoarthritis in Greece. The ESORDIG study. J Rheumatol. 2006;33:2507–2513.PubMedGoogle Scholar
  2. 2.
    Bedeian AG, Mossholder KW. On the use of the coefficient of variation as a measure of diversity. Org Res Methods. 2000;3:285–297.CrossRefGoogle Scholar
  3. 3.
    Birrell F, Lunt M, Macfarlane G, Silman A. Association between pain in the hip region and radiographic changes of osteoarthritis: results from a population-based study. Rheumatology (Oxford). 2005;44:337–341.CrossRefGoogle Scholar
  4. 4.
    Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis: implications for research. Clin Orthop Relat Res. 2004;427(Suppl):S6–S15.Google Scholar
  5. 5.
    Burger H, van Daele PL, Odding E, Valkenburg HA, Hofman A, Grobbee DE, Schutte HE, Birkenhager JC, Pols HA. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam Study. Arthritis Rheum. 1996;39:81–86.PubMedCrossRefGoogle Scholar
  6. 6.
    Corti MC, Rigon C. Epidemiology of osteoarthritis: prevalence, risk factors and functional impact. Aging Clin Exp Res. 2003;15:359–363.PubMedGoogle Scholar
  7. 7.
    Cvijetic S, Campbell L, Cooper C, Kirwan J, Potoeki K. Radiographic osteoarthritis in the elderly population of Zagreb: distribution, correlates, and the pattern of joint involvement. Croatian Med. J. 2000;41:58–63.Google Scholar
  8. 8.
    D’Ambrosia RD. Epidemiology of osteoarthritis. Orthopedics. 2005;28:s201-s205.PubMedGoogle Scholar
  9. 9.
    Danielsson L, Lindberg H. Prevalence of coxarthrosis in an urban population during four decades. Clin Orthop Relat Res. 1997;342:106–110.PubMedCrossRefGoogle Scholar
  10. 10.
    Felson DT. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev. 1988;10:1–28.PubMedGoogle Scholar
  11. 11.
    Felson DT. Preventing knee and hip osteoarthritis. Bull Rheum Dis. 1998;47:1–4.PubMedGoogle Scholar
  12. 12.
    Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am. 2004;42:1–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Frankel S, Eachus J, Pearson N, Greenwood R, Chan P, Peters TJ, Donovan J, Smith GD, Dieppe P. Population requirement for primary hip-replacement surgery: a cross-sectional study. Lancet. 1999;353:1304–1309.PubMedCrossRefGoogle Scholar
  14. 14.
    Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272.PubMedCrossRefGoogle Scholar
  15. 15.
    Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMedGoogle Scholar
  16. 16.
    Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ. Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. Am J Med. 1999;107:542–548.PubMedCrossRefGoogle Scholar
  17. 17.
    Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000;133:321–328.PubMedGoogle Scholar
  18. 18.
    Groeneveld PW, Kwoh CK, Mor MK, Appelt CJ, Geng M, Gutierrez JC, Wessel DS, Ibrahim SA. Racial differences in expectations of joint replacement surgery outcomes. Arthritis Rheum. 2008;59:730–737.PubMedCrossRefGoogle Scholar
  19. 19.
    Grubber JM, Callahan LF, Helmick CG, Zack MM, Pollard RA. Prevalence of radiographic hip and knee osteoarthritis by place of residence. J Rheumatol. 1998;25:959–963.PubMedGoogle Scholar
  20. 20.
    Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. 1986;213:20–33.PubMedGoogle Scholar
  21. 21.
    Hartofilakidis G, Karachalios T. Idiopathic osteoarthritis of the hip: incidence, classification, and natural history of 272 cases. Orthopedics. 2003;26:161–166.PubMedGoogle Scholar
  22. 22.
    Helmick C, Renner JB, Luta G, Dragomir AD, Kalsbeek W, Abbate L, et al. Prevalence of hip pain, radiographic hip osteoarthritis (OA), severe radiographic hip OA, and symptomatic hip OA: the Johnson County Osteoarthritis Project [Abstract]. Arthritis Rheum. 2003;48(Suppl 9):S212.Google Scholar
  23. 23.
    Hirsch R, Fernandes RJ, Pillemer SR, Hochberg MC, Lane NE, Altman RD, Bloch DA, Knowler WC, Bennett PH. Hip osteoarthritis prevalence estimates by three radiographic scoring systems. Arthritis Rheum. 1998;41:361–368.PubMedCrossRefGoogle Scholar
  24. 24.
    Hootman JM, Macera CA, Helmick CG, Blair SN. Influence of physical activity-related joint stress on the risk of self-reported hip/knee osteoarthritis: a new method to quantify physical activity. Prev Med. 2003;36:636–644.PubMedCrossRefGoogle Scholar
  25. 25.
    Horvath G, Than P, Bellyei A, Kranicz J, Illes T. Prevalence of degenerative joint complaints of the lower extremity: a representative study. Int Orthop. 2006;30:118–122.PubMedCrossRefGoogle Scholar
  26. 26.
    Ingvarsson T. Prevalence and inheritance of hip osteoarthritis in Iceland. Acta Orthop Scand Suppl. 2000;298:1–46.PubMedGoogle Scholar
  27. 27.
    Ingvarsson T, Hagglund G, Lindberg H, Lohmander LS. Assessment of primary hip osteoarthritis: comparison of radiographic methods using colon radiographs. Ann Rheum Dis. 2000;59:650–653.PubMedCrossRefGoogle Scholar
  28. 28.
    Ingvarsson T, Hagglund G, Lohmander LS. Prevalence of hip osteoarthritis in Iceland. Ann Rheum Dis. 1999;58:201–207.PubMedCrossRefGoogle Scholar
  29. 29.
    Inoue K, Wicart P, Kawasaki T, Huang J, Ushiyama T, Hukuda S, Courpied J. Prevalence of hip osteoarthritis and acetabular dysplasia in French and Japanese adults. Rheumatology (Oxford). 2000;39:745–748.CrossRefGoogle Scholar
  30. 30.
    Jacobsen S, Sonne-Holm S. Hip dysplasia: a significant risk factor for the development of hip osteoarthritis. A cross-sectional survey. Rheumatology (Oxford). 2005;44:211–218.CrossRefGoogle Scholar
  31. 31.
    Jacobsen S, Sonne-Holm S, Soballe K, Gebuhr P, Lund B. Radiographic case definitions and prevalence of osteoarthrosis of the hip: a survey of 4 151 subjects in the Osteoarthritis Substudy of the Copenhagen City Heart Study. Acta Orthop Scand. 2004;75:713–720.PubMedCrossRefGoogle Scholar
  32. 32.
    Jarvholm B, Lewold S, Malchau H, Vingard E. Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men. Eur J Epidemiol. 2005;20:537–542.PubMedCrossRefGoogle Scholar
  33. 33.
    Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.PubMedCrossRefGoogle Scholar
  34. 34.
    Kim HA, Koh SH, Lee B, Kim IJ, Seo YI, Song YW, Hunter DJ, Zhang Y. Low rate of total hip replacement as reflected by a low prevalence of hip osteoarthritis in South Korea. Osteoarthritis Cartilage. 2008 Jun 14 [Epub ahead of print].Google Scholar
  35. 35.
    Lane NE, Nevitt MC, Genant HK, Hochberg MC. Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol. 1993;20:1911–1918.PubMedGoogle Scholar
  36. 36.
    Lau EM, Symmons DP, Croft P. The epidemiology of hip osteoarthritis and rheumatoid arthritis in the Orient. Clin Orthop Relat Res. 1996;323:81–90.PubMedCrossRefGoogle Scholar
  37. 37.
    Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26–35.PubMedCrossRefGoogle Scholar
  38. 38.
    Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778–799.PubMedCrossRefGoogle Scholar
  39. 39.
    Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can. 1998;19:170–176.PubMedGoogle Scholar
  40. 40.
    Mannoni A, Briganti MP, Di Bari M, Ferrucci L, Costanzo S, Serni U, Masotti G, Marchionni N. Epidemiological profile of symptomatic osteoarthritis in older adults: a population based study in Dicomano, Italy. Ann Rheum Dis. 2003;62:576–578.PubMedCrossRefGoogle Scholar
  41. 41.
    Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965;38:810–824.PubMedGoogle Scholar
  42. 42.
    Nevitt MC, Cummings SR, Lane NE, Hochberg MC, Scott JC, Pressman AR, Genant HK, Cauley JA. Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1996;156:2073–2080.PubMedCrossRefGoogle Scholar
  43. 43.
    Nevitt MC, Xu L, Zhang Y, Lui LY, Yu W, Lane NE, Qin M, Hochberg MC, Cummings SR, Felson DT. Very low prevalence of hip osteoarthritis among Chinese elderly in Beijing, China, compared with whites in the United States: the Beijing osteoarthritis study. Arthritis Rheum. 2002;46:1773–1779.PubMedCrossRefGoogle Scholar
  44. 44.
    Odding E, Valkenburg HA, Algra D, Vandenouweland FA, Grobbee DE, Hofman A. Associations of radiological osteoarthritis of the hip and knee with locomotor disability in the Rotterdam Study. Ann Rheum Dis. 1998;57:203–208.PubMedCrossRefGoogle Scholar
  45. 45.
    Petersson IF, Jacobsson LT. Osteoarthritis of the peripheral joints. Baillieres Best Pract Res Clin Rheumatol. 2002;16:741–760.CrossRefGoogle Scholar
  46. 46.
    Reijman M, Hazes JM, Koes BW, Verhagen AP, Bierma-Zeinstra SM. Validity, reliability, and applicability of seven definitions of hip osteoarthritis used in epidemiological studies: a systematic appraisal. Ann Rheum Dis. 2004;63:226–232.PubMedCrossRefGoogle Scholar
  47. 47.
    Reijman M, Hazes JM, Pols HA, Bernsen RM, Koes BW, Bierma-Zeinstra SM. Validity and reliability of three definitions of hip osteoarthritis: cross sectional and longitudinal approach. Ann Rheum Dis. 2004;63:1427–1433.PubMedCrossRefGoogle Scholar
  48. 48.
    Reijman M, Hazes JM, Pols HA, Bernsen RM, Koes BW, Bierma-Zeinstra SM. Role of radiography in predicting progression of osteoarthritis of the hip: prospective cohort study. BMJ. 2005;330:1183.PubMedCrossRefGoogle Scholar
  49. 49.
    Reijman M, Pols HA, Bergink AP, Hazes JM, Belo JN, Lievense AM, Bierma-Zeinstra SM. Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study. Ann Rheum Dis. 2007;66:158–162.PubMedCrossRefGoogle Scholar
  50. 50.
    Resnick D. The ‘tilt deformity’ of the femoral head in osteoarthritis of the hip: a poor indicator of previous epiphysiolysis. Clin Radiol. 1976;27:355–363.PubMedCrossRefGoogle Scholar
  51. 51.
    Resnick D, Niwayama G. Degenerative Disease of Extraspinal Locations. Diagnosis of Bone and Joint Disorders. 2nd Ed. Philadelphia, PA: WB Saunders; 1988.Google Scholar
  52. 52.
    Rogers LQ, Macera CA, Hootman JM, Ainsworth BE, Blairi SN, Rogers LQ, Macera CA, Hootman JM, Ainsworth BE, Blairi SN. The association between joint stress from physical activity and self-reported osteoarthritis: an analysis of the Cooper Clinic data. Osteoarthritis Cartilage. 2002;10:617–622.PubMedCrossRefGoogle Scholar
  53. 53.
    Sowers M. Epidemiology of risk factors for osteoarthritis: systemic factors. Curr Opin Rheumatol. 2001;13:447–451.PubMedCrossRefGoogle Scholar
  54. 54.
    van Saase JL, van Romunde LK, Cats A, Vandenbroucke JP, Valkenburg HA. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis. 1989;48:271–280.PubMedCrossRefGoogle Scholar
  55. 55.
    Yoshimura N, Campbell L, Hashimoto T, Kinoshita H, Okayasu T, Wilman C, Coggon D, Croft P, Cooper C. Acetabular dysplasia and hip osteoarthritis in Britain and Japan. Br J Rheumatol. 1998;37:1193–1197.PubMedCrossRefGoogle Scholar
  56. 56.
    Zhang W, Doherty M. EULAR recommendations for knee and hip osteoarthritis: a critique of the methodology. Br J Sports Med. 2006;40:664–669.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Simon Dagenais
    • 1
    • 2
  • Shawn Garbedian
    • 1
  • Eugene K. Wai
    • 1
  1. 1.Division of Orthopaedics, Faculty of MedicineUniversity of OttawaOttawaCanada
  2. 2.Department of Epidemiology and Community Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada

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