Life Course Epidemiology of Hip Osteoarthritis in Japan

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.

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“…A case-cohort study by Bruin et al [ 16 ] found that perioperative dosing of PPIs is associated with increased prosthetic joint infections. According to a multicenter, cross-sectional study conducted in 2022 in Japan, the mean age of new patients with hip osteoarthritis was 63.5 years [ 53 ], and those patients with osteoarthritis may undergo joint replacement surgery after taking NSAIDs for an extended duration [ 54 ]. However, infection and periprosthetic fractures are serious complications of joint replacement surgery [ 55 ].…”

Chiropractic rehabilitation in accelerated rehabilitation after total hip arthroplasty for Crowe type IV hip dysplasia

“…Developmental dysplasia of the hip (DDH), which includes DDH, hip subluxation, or hip dislocation, is a major disorder of hip pain and deformity. [ 1 – 3 ] Dysplastic acetabulum is characterized by a small diameter, defective bone structure, and proximalization of the femoral head. Femoral challenges include medullary canal stenosis, excessive anterior tilt, and high diaphragm-diaphragm angle with epiphyseal mismatch.…”

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“…conducted in 2022 in Japan, the mean age of new patients with hip osteoarthritis was 63.5 years [53], and those patients with osteoarthritis may undergo joint replacement surgery after taking NSAIDs for an extended duration [54]. However, infection and periprosthetic fractures are serious complications of joint replacement surgery [55].…”