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Hip Ontogenesis: How Evolution, Genes, and Load History Shape Hip Morphotype and Cartilotype

  • Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Developmental hip disorders (DHDs), eg, developmental dysplasia of the hip, slipped capitis femoris epiphysis, and femoroacetabular impingement, can be considered morphology variants of the normal hip. The femoroacetabular morphology of DHD is believed to induce osteoarthritis (OA) through local cumulative mechanical overload acting on genetically controlled patterning systems and subsequent damage of joint structures. However, it is unclear why hip morphology differs between individuals with seemingly comparable load histories and why certain hips with DHD progress to symptomatic OA whereas others do not.

Questions/Purposes

We asked (1) which mechanical factors influence growth and development of the proximal femur; and (2) which genes or genetic mechanisms are associated with hip ontogenesis.

Methods

We performed a systematic literature review of mechanical and genetic factors of hip ontogeny. We focused on three fields that in recent years have advanced our knowledge of adult hip morphology: imaging, evolution, and genetics.

Where Are We Now?

Mechanical factors can be understood in view of human evolutionary peculiarities and may summate to load histories conducive to DHD. Genetic factors most likely act through multiple genes, each with modest effect sizes. Single genes that explain a DHD are therefore unlikely to be found. Apparently, the interplay between genes and load history not only determines hip morphotype, but also joint cartilage robustness (“cartilotype”) and resistance to symptomatic OA.

Where Do We Need to Go?

We need therapies that can improve both morphotype and cartilotype.

How Do We Get There?

Better phenotyping, improving classification systems of hip morphology, and comparative population studies can be done with existing methods. Quantifying load histories likely requires new tools, but proof of principle of modifying morphotype in treatment of DDH and of cartilotype with exercise is available.

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Author information

Authors and Affiliations

  1. Orthopaedic Surgeon, Haga Hospital, The Hague, The Netherlands

    Tom Hogervorst MD, PhD

  2. Leiden University Medical Center, Leiden, The Netherlands

    Wouter Eilander MD & Joost T. Fikkers MSc

  3. Leiden University Medical Center, The Netherlands Consortium for Healthy Aging, Leiden, The Netherlands

    Ingrid Meulenbelt PhD

Authors
  1. Tom Hogervorst MD, PhD
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  2. Wouter Eilander MD
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  3. Joost T. Fikkers MSc
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  4. Ingrid Meulenbelt PhD
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Corresponding author

Correspondence to Tom Hogervorst MD, PhD.

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Appendix: search strategy and criteria

Appendix: search strategy and criteria

We performed three searches in Medline, Embase, and Web of Science summarizing the literature on mechanical and genetic factors of hip growth and development. For these searches we formed six groups of search terms and one group with exclusion terms composed of the first three authors in joint discussion. The first group, Group A, referred to terms related to “the hip”, Group B to “growth and development”, Group C to “mechanical factors”, Group D to “genetic factors”, Group E to “DHD”, and Group F referred to “prevalence”. Group G consisted of exclusion terms and was composed of selecting irrelevant title words found during pilot searches.

For each search we combined three groups of terms. For example, to investigate the influence of mechanical factors on hip growth and development, we combined Group A, B, and C. They were connected using the Boolean operator AND. In addition, Group G was added using the Boolean operator NOT. Terms within a group were combined with the Boolean operator OR. All used search terms and group combinations are reported in the Appendix. The search field was “title and abstract” combined with MESH terms when using Medline. The search field for exclusion terms was “title” only. The three searches resulted in three lists of articles for each database. These lists were then searched based on titles and abstracts and had to contain specific reference to mechanical or genetic aspects of hip ontogeny, or imaging and image analysis, or evolution, embryology, or genes. Articles that did not contain any of these subjects were excluded. Also, articles written in other languages than English, German, French, or Dutch were excluded. After selection, further articles were added from reference lists of included articles.

The first search, regarding the effect of mechanical phenomena on growth and development of the proximal femur in both humans and animals, yielded over 13,500 results. The second search for genes and genetic mechanisms associated with skeletogenesis and the hip resulted in more than 8500 articles. The third search was focused on the prevalence of DDH, SCFE, and FAI with regard to different populations, twin studies, and sex. Over 3500 articles were found.

Of the more than 25,500 publications found in total, 25,330 were irrelevant based on duplicates, title, and abstract, leaving 170 publications for evaluation (Fig. 2).

 

A

Terms related to the hip

B

Terms related to growth and development

C

Terms related to mechanical factors

D

Terms related to genetic factors

E

Terms related to DDH, SCFE, FAI

F

Terms related to prevalence

G

Exclusion terms

hip

femur

head

femoral

head

femur

neck

femoral

neck

femoral

torsion

proximal

femur

proximal

femoral

acetabulum

Epiphyses

epiphysis

growth

plate

development

growth

ontogeny

fetus

fetal

intrauterine

intra-uterine

intra uterine

prenatal

pregnancy

trimester

antenatal

young

adolescent

child

infant

children

childhood

puberty

neonatal

neonate

neonates

toddler

toddlers

schoolchildren

schoolchild

infants

youth

evolution

biomechanics

stress

sports

sporting

athletic

activity

weight-Bearing

weight Bearing

exercise

movement

posture

load

loading

gait

mechanical

running

motor

activity

locomotion

pressure

stability

shape

genetic

genes

gene

aetiology

etiology

genetics

polymorphism

twins

twin

family

gdf5

frzb

dio2

calm1

smad3

biological evolution

impingement

FAI

dislocation

hip

dysplasia

disease

hip

slipped

epiphysiolysis

epiphysiolyses

SCFE

DDH

cam

pincer

SUFE

morphology

morphometric

ethnic

prevalence

incidence

gender

population

asian

asia

japanese

japan

africa

european

britain

french

north american

north america

german

germany

Spanish

spain

racial

race

caucasians

caucasian

chinese

china

korea

korean

united kingdom

france

cerebral palsy

prostheses

osteotomy

fracture

fractures

arthroplasty

replacement

implant

implants

obesity

diabetes

blood pressure

adiposity

component

components

obese

metabolic

syndrome

liver

cardiovascular

  1. List of the terms used in the searches categorized in seven groups. Terms within a group were combined using the Boolean operator OR.
  2. To find publications on the effect of mechanical factors on hip growth and development, we combined search terms A AND B AND C NOT G.
  3. To find publications regarding genetic factors associated with hip growth and development, we combined A AND B AND D NOT G.
  4. To find publications on prevalence of DDH, SCFE, and FAI in different populations, we combined search terms A AND E AND F NOT G.

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Hogervorst, T., Eilander, W., Fikkers, J.T. et al. Hip Ontogenesis: How Evolution, Genes, and Load History Shape Hip Morphotype and Cartilotype. Clin Orthop Relat Res 470, 3284–3296 (2012). https://doi.org/10.1007/s11999-012-2511-4

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