A population-based study of the association between hip bone marrow lesions, high cartilage signal, and hip and knee pain

Abstract

The objective of this study was to describe the cross-sectional and longitudinal relationship between hip bone marrow lesions (BMLs), high cartilage signal, and hip and knee pain. One hundred ninety-eight participants in the Tasmanian Older Adult Cohort Study with right hip MRI conducted at two time points, approx. 2.3 years apart, were included. Short T1 Inversion Recovery MR images were used to quantitatively measure hip BML size and determine high cartilage signal presence. Hip and knee pain were individually assessed using the Western Ontario and McMaster Universities Osteoarthritis index pain score. Fifty-five participants (28%) had either femoral and/or acetabular BMLs. Cross-sectionally, the presence of large femoral, acetabular, or any hip BMLs was associated with higher odds of hip pain (OR = 4.42, 95% CI = 1.37-19.7; OR = 5.23, 95% CI = 1.17-22.9; OR = 4.43, 95% CI = 1.46-13.2, respectively). High cartilage signal was strongly associated with hip BMLs (OR = 6.45, 95% CI = 3.37-12.6), but not with pain. Longitudinally, incident acetabular (Mean diff = +5.90, 95% CI = +3.78 to +8.15) and femoral BMLs (Mean diff = +1.18, 95% CI = 0.23-1.94) were associated with worsening hip pain, while resolving femoral BMLs were associated with a decrease in knee pain (Mean diff = -3.18, 95% CI = -5.99 to -0.50). The evidence is consistent for hip, but not knee pain, and strongly suggests that large hip BMLs are associated with hip pain. Furthermore, high cartilage signal is asymptomatic, but strongly associated with hip BMLs. These findings suggest that hip BMLs play an important role in hip osteoarthritis.

Hip Shape as a Predictor of Osteoarthritis Progression in a Prospective Population Cohort

“…Although OA is a disease of the whole joint, bone and cartilage remain the focus of its clinical manifestation . Structural changes such as bone marrow lesions (BMLs) and cartilage defects are linked with the progression of hip OA . In addition to these, the morphology of the hip can predict the development of hip OA , but most current assessments are semiquantitative and focus on changes in the cartilage and the presence of bony outgrowths .…”

MRI and the distribution of bone marrow fat in hip osteoarthritis

“…Radiographic joint space narrowing is currently the only biomarker accepted by the Federal Drug Administration in the USA but its lack of sensitivity requires studies to have large sample sizes and prolonged duration. Measures of joint space width using MRI and the application of newer MR methods, such as dGEMRIC to assess cartilage composition, assessment of glycosaminoglycan content using saturation transfer, and T 1 rho still focus on changes in cartilage, but the detection of bone marrow lesions is broadening the whole area of MRI biomarkers . In this study we used MRI to measure the fractional fat content within the bone marrow in the proximal femur in patients with different severities of OA and characterized its distribution using statistical measures of image texture with a view to assessing its potential as an imaging biomarker.…”

MRI-based hip cartilage measures in osteoarthritic and non-osteoarthritic individuals: a systematic review

“…43 44 Instead of providing quantitative hip cartilage measurements, two studies provided semiquantitative data regarding hip cartilage signal changes, description or quantification of hip cartilage defects, and/or quantification of other MR cartilage parameters such as relaxometry. 35 39 OA defining criteria were not used in five studies. 11 28 30 38 One study 36 used an MRI-based scoring system for OA (Hip Osteoarthritis MRI Scoring System, HOAMS 37 ), whereas the remaining studies used radiographic grading of hip OA as per the Kellgren-Lawrence (K-L) score or Altman atlas.…”