Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Jun 5;106(11):966-975.
doi: 10.2106/JBJS.23.01044. Epub 2024 Apr 16.

Life Course Epidemiology of Hip Osteoarthritis in Japan: A Multicenter, Cross-Sectional Study

Taishi Sato  1 , Satoshi Yamate  1 , Takeshi Utsunomiya  1 , Yutaka Inaba  2 , Hiroyuki Ike  2 , Koichi Kinoshita  3 , Kenichiro Doi  3 , Tsutomu Kawano  4 , Kyohei Shiomoto  4 , Toshihiko Hara  5 , Kazuhiko Sonoda  5 , Ayumi Kaneuji  6 , Eiji Takahashi  6 , Tomohiro Shimizu  7 , Daisuke Takahashi  7 , Yusuke Kohno  8 , Tamon Kabata  9 , Daisuke Inoue  9 , Shuichi Matsuda  10 , Koji Goto  10 , Taro Mawatari  11 , Shoji Baba  11 , Michiaki Takagi  12 , Juji Ito  12 , Yasuharu Nakashima  1 ; the Japanese Hip OA Consortium
Collaborators, Affiliations
Multicenter Study

Life Course Epidemiology of Hip Osteoarthritis in Japan: A Multicenter, Cross-Sectional Study

Taishi Sato et al. J Bone Joint Surg Am. .

Abstract

Background: The incidence of developmental dysplasia of the hip (DDH) in Japanese newborns has reduced drastically following a primary prevention campaign initiated around 1972 to 1973; this perinatal education campaign promoted maintaining the hips of newborns in the naturally flexed-leg position. The purpose of the present study was to describe the life course epidemiology of hip osteoarthritis (OA) in adolescent and adult patients and to assess its association with exposure to the primary prevention campaign for DDH.

Methods: We included new patients with hip OA diagnosed from January 1, 2022, to December 31, 2022, at 12 core hospitals (8 special-function hospitals and 4 regional medical care support hospitals). The trend in the percentage of hips with a history of DDH treatment in childhood was estimated with use of a centered moving average using the birth year of the patient. We compared the prevalence of severe subluxation (Crowe type II, III, or IV) between patients with secondary hip OA due to hip dysplasia who were born in or before 1972 and those who were born in or after 1973.

Results: Overall, 1,095 patients (1,381 hips) were included. The mean age at the time of the survey was 63.5 years (range, 15 to 95 years). A total of 795 patients (1,019 hips; 73.8% of hips) were diagnosed with secondary OA due to hip dysplasia. Approximately 13% to 15% of hips among patients born from 1963 to 1972 had a history of DDH treatment in childhood; however, the percentage decreased among patients born in or after 1973. The prevalence of severe subluxation (Crowe type II, III, or IV) among patients born in or after 1973 was 2.4%, which was significantly less than that among patients born in or before 1972 (11.1%; odds ratio, 0.20; p < 0.001).

Conclusions: As of 2022, secondary hip OA due to hip dysplasia is still responsible for most new cases of adolescent and adult hip OA seen in core hospitals in Japan. However, the perinatal education campaign initiated 50 years ago, which utilized a population approach and advocated for maintaining the hips of newborns in the naturally flexed-leg position, may have improved the environmental factors of DDH, as indicated by the apparently reduced need for treatment of DDH in childhood and the associated severe subluxation. This may result in a reduced need for challenging hip surgery later in life.

Level of evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

Disclosure: This work was supported by the Japan Society for the Promotion of Science (KAKENHI) (grant JP23K08654). The Article Processing Charge for open access publication was funded by the Japan Society for the Promotion of Science (KAKENHI) (grant JP23K08654). The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H969 ).

Figures

Fig. 1
Fig. 1
Radiograph demonstrating a once-typical case of hip osteoarthritis (OA) in Japan. The radiograph shows the hips of a female patient born in 1964 who had a history of DDH treatment in childhood. She began experiencing hip pain in her mid-40s and first visited a core hospital at 58 years old. We diagnosed both hips as having secondary OA due to hip dysplasia; the left hip showed Crowe type-II subluxation.
Fig. 2
Fig. 2
Flow diagram showing the patient-selection process for the analysis. The prefectures in gray indicate the location of the 12 core hospitals (8 special-function hospitals and 4 regional medical care support hospitals) that participated in the study.
Fig. 3
Fig. 3
Diagnostic criteria of the hip OA subclassification. This algorithm was shared with the 12 core hospitals before January 1, 2022. The final diagnoses were determined by a conference at each facility; therefore, a reliability assessment was not performed. If the diagnosis was inconclusive, a consensus meeting was held among members of the collaborating institutions. OA = osteoarthritis, RDC = rapidly destructive coxopathy, LCPD = Legg-Calvé-Perthes disease, SCFE = slipped capital femoral epiphysis, DDH = developmental dysplasia of the hip, LCEA = lateral center-edge angle, ARO = acetabular roof obliquity, FAI = femoroacetabular impingement, MRI = magnetic resonance imaging, SIF = subchondral insufficiency fracture.
Fig. 4
Fig. 4
Histogram showing the number of hips with new hip OA (gray bars) and the number of such hips with a history of DDH treatment in childhood (black bars) by birth year. A line for the 20-year centered moving average was utilized to estimate the trend in the percentage of hips with a history of DDH treatment in childhood across birth years.
Fig. 5
Fig. 5
Histograms showing the number of hips with secondary hip OA due to hip dysplasia, by Crowe classification and birth year.
See this image and copyright information in PMC

References

    1. Jingushi S, Ohfuji S, Sofue M, Hirota Y, Itoman M, Matsumoto T, Hamada Y, Shindo H, Takatori Y, Yamada H, Yasunaga Y, Ito H, Mori S, Owan I, Fujii G, Ohashi H, Iwamoto Y, Miyanishi K, Iga T, Takahira N, Sugimori T, Sugiyama H, Okano K, Karita T, Ando K, Hamaki T, Hirayama T, Iwata K, Nakasone S, Matsuura M, Mawatari T. Multiinstitutional epidemiological study regarding osteoarthritis of the hip in Japan. J Orthop Sci. 2010. Sep;15(5):626-31. - PubMed
    1. Leavell HR, Clark EG. Preventive medicine for the doctor in his community: an epidemiologic approach. 3rd ed. McGraw-Hill; 1965.
    1. Murphy NJ, Eyles JP, Hunter DJ. Hip osteoarthritis: etiopathogenesis and implications for management. Adv Ther. 2016. Nov;33(11):1921-46. - PMC - PubMed
    1. Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health. 2003. Oct;57(10):778-83. - PMC - PubMed
    1. Ang KC, Lee EH, Lee PY, Tan KL. An epidemiological study of developmental dysplasia of the hip in infants in Singapore. Ann Acad Med Singap. 1997. Jul;26(4):456-8. - PubMed

Publication types