Identifying muscle function-based phenotypes associated with radiographic progression of secondary hip osteoarthritis: A prospective cohort study

Arch Phys Med Rehabil. 2023 May 23;S0003-9993(23)00296-4. doi: 10.1016/j.apmr.2023.04.024. Online ahead of print.


Objective: The purposes of our study were to (1) identify muscle function-based clinical phenotypes in patients with hip osteoarthritis (OA) and (2) determine the association between those phenotypes and radiographic progression of hip OA.

Design: Prospective cohort study.

Setting: Clinical biomechanics laboratory of a university.

Participants: Fifty female patients with mild-to-moderate secondary hip OA were recruited from the orthopaedic department of a single institution.

Interventions: Not applicable.

Main outcome measures: Two-step cluster analyses were performed to classify the patients, using hip flexion, extension, abduction, and external/internal rotation muscle strength (cluster analysis 1); relative hip muscle strength to total hip strength (i.e., hip muscle strength balance; cluster analysis 2); and both hip muscle strength and muscle strength balance (cluster analysis 3) as variables. The association between the phenotype and hip OA progression over 12 months (indicated by joint space width [JSW] >0.5mm) was investigated by logistic regression analyses. Hip joint morphology, hip pain, gait speed, physical activity, Harris hip score, and SF-36 scores were compared between the phenotypes.

Results: Radiographic progression of hip OA was observed in 42% of the patients. The patients were classified into two phenotypes in each of the three cluster analyses. The solution in cluster analyses 1 and 3 was similar, and high-function and low-function phenotypes were identified; however, no association was found between the phenotypes and hip OA progression. The phenotype 2-1 (high-risk phenotype) extracted in cluster analysis 2, which had relative muscle weakness in hip flexion and internal rotation, was associated with subsequent hip OA progression, even after adjusting for age and minimum JSW at baseline (adjusted odds ratio [95% confidence interval], 3.60 [1.07-12.05]; p = 0.039).

Conclusion: As preliminary findings, the phenotype based on hip muscle strength balance, rather than hip muscle strength, may be associated with hip OA progression.

Keywords: Cluster analysis; Disease Progression; Muscle Strength; Osteoarthritis; Phenotype.