A prospective cohort study on cam morphology and its role in progression of osteoarthritis

Harbeer Ahedi*, Tania Winzenberg, Sita Bierma-Zeinstra, Leigh Blizzard, Marienke van Middelkoop, Rintje Agricola, Jan H. Waarsing, Flavia Cicuttini, Graeme Jones

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: Cam morphology contributes to the development of hip osteoarthritis (OA) but is less studied in the general population. This study describes its associations with clinical and imaging features of hip OA. Methods: Anteroposterior hip radiographs of 1019 participants from the Tasmanian Older Adult Cohort (TASOAC) were scored at baseline for α angle (cam morphology) in both hips. Using the Altman's atlas, radiographic hip OA (ROA) was assessed at baseline. Hip pain and right hip structural changes were assessed on a subset of 245 magnetic resonance images (MRI) at 5 years. Joint registry data for total hip replacement (THR) was acquired 14 years from baseline. Results: Of 1906 images, cam morphology was assessed in 1016 right and 890 left hips. Cross-sectionally, cam morphology modestly associated with age (prevalence ratio [PR]: 1.02 P =.03) and body mass index (BMI) (PR: 1.03-1.07, P =.03) and strongly related to male gender (PR: 2.96, P <.001). Radiographically, cam morphology was prevalent in those with decreased joint space (PR: 1.30 P =.03) and osteophytes (PR: 1.47, P =.03). Longitudinally, participants with right cam and high BMI had more hip pain (PR: 17.9, P =.02). At the end of 5 years of follow-up these participants were also more likely to have structural changes such as bone marrow lesions (BMLs) (PR: 1.90 P =.04), cartilage defects (PR: 1.26, P =.04) and effusion-synovitis at multiple sites (PR: 1.25 P =.02). Cam morphology at baseline in either hip predicted up to threefold risk of THR (PR: 3.19, P =.003) at the end of 14 years. Conclusion: At baseline, cam morphology was linked with age, higher weight, male gender, early signs of radiographic OA such as joint space narrowing (JSN) and osteophytes (OST). At follow-up, cam predicted development of hip BMLs, hip effusion-synovitis, cartilage damage and THR. These findings suggest that cam morphology plays a significant role in early OA and can be a precursor or contribute to hip OA in later life.

Original languageEnglish
Pages (from-to)601-612
Number of pages12
JournalInternational Journal of Rheumatic Diseases
Issue number5
Early online date9 Mar 2022
Publication statusPublished - May 2022

Bibliographical note

Funding Information:
HA was funded by an Australian Government Postgraduate Award, and this study was supported by Arthritis Australia. The TASOAC study was supported by the National Health and Medical Research Council of Australia, Tasmanian Community Fund, Masonic Centenary Medical Research Foundation, Royal Hobart Hospital Research Foundation and Arthritis Foundation of Australia.

Publisher Copyright:
© 2022 The Authors. International Journal of Rheumatic Diseases published by Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.


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