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. 2004 Mar;63(3):226–232. doi: 10.1136/ard.2003.010348

Validity, reliability, and applicability of seven definitions of hip osteoarthritis used in epidemiological studies: a systematic appraisal

M Reijman 1, J Hazes 1, B Koes 1, A Verhagen 1, S Bierma-Zeinstra 1
PMCID: PMC1754907  PMID: 14962953

Abstract

Methods: Medline and Embase were searched and articles studying the validity, reliability, or applicability of the definitions of hip OA were selected. Two reviewers independently extracted data on the quality of the seven definitions.

Results: Review of the literature showed the validity of the various definitions of hip OA, in particular, has barely been investigated. Minimal joint space (MJS) demonstrated the highest (intra- and interrater) reliability, and showed the highest association with hip pain and restricted internal rotation compared with the other definitions of hip OA. The reliability of the Kellgren and Lawrence grade and the index according to Lane is comparable with that of the MJS, but the construct validity should be investigated more thoroughly. The reliability and validity according to the Croft grade were inferior to the MJS, the Kellgren and Lawrence grade, and the index according to Lane. Despite precise and extensive development, the ACR criteria showed poor reliability and poor cross-validity (agreement between three ACR criteria sets) in a primary care setting.

Conclusions: The reliabilities of MJS, Kellgren and Lawrence, and the index according to Lane were comparable, but the MJS had the highest relationship with hip pain in a male population. Considering how often definitions of hip OA are used, it is surprising that the validity has been so poorly investigated, and the validity needs to be studied more thoroughly.

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Selected References

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  1. Altman R., Alarcón G., Appelrouth D., Bloch D., Borenstein D., Brandt K., Brown C., Cooke T. D., Daniel W., Feldman D. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991 May;34(5):505–514. doi: 10.1002/art.1780340502. [DOI] [PubMed] [Google Scholar]
  2. Antoniades L., MacGregor A. J., Matson M., Spector T. D. A cotwin control study of the relationship between hip osteoarthritis and bone mineral density. Arthritis Rheum. 2000 Jul;43(7):1450–1455. doi: 10.1002/1529-0131(200007)43:7<1450::AID-ANR6>3.0.CO;2-6. [DOI] [PubMed] [Google Scholar]
  3. Bellamy N., Klestov A., Muirden K., Kuhnert P., Do K. A., O'Gorman L., Martin N. Perceptual variation in categorizing individuals according to American College of Rheumatology classification criteria for hand, knee, and hip osteoarthritis (OA): observations based on an Australian Twin Registry study of OA. J Rheumatol. 1999 Dec;26(12):2654–2658. [PubMed] [Google Scholar]
  4. Bierma-Zeinstra S., Bohnen A., Ginai A., Prins A., Verhaar J. Validity of American College of Rheumatology criteria for diagnosing hip osteoarthritis in primary care research. J Rheumatol. 1999 May;26(5):1129–1133. [PubMed] [Google Scholar]
  5. Birrell F., Croft P., Cooper C., Hosie G., Macfarlane G. J., Silman A. Radiographic change is common in new presenters in primary care with hip pain. PCR Hip Study Group. Rheumatology (Oxford) 2000 Jul;39(7):772–775. doi: 10.1093/rheumatology/39.7.772. [DOI] [PubMed] [Google Scholar]
  6. Birrell F., Croft P., Cooper C., Hosie G., Macfarlane G., Silman A., PCR Hip Study Group Predicting radiographic hip osteoarthritis from range of movement. Rheumatology (Oxford) 2001 May;40(5):506–512. doi: 10.1093/rheumatology/40.5.506. [DOI] [PubMed] [Google Scholar]
  7. Buchbinder R., Goel V., Bombardier C., Hogg-Johnson S. Classification systems of soft tissue disorders of the neck and upper limb: do they satisfy methodological guidelines? J Clin Epidemiol. 1996 Feb;49(2):141–149. doi: 10.1016/0895-4356(95)00519-6. [DOI] [PubMed] [Google Scholar]
  8. Byrt T., Bishop J., Carlin J. B. Bias, prevalence and kappa. J Clin Epidemiol. 1993 May;46(5):423–429. doi: 10.1016/0895-4356(93)90018-v. [DOI] [PubMed] [Google Scholar]
  9. Croft P., Cooper C., Coggon D. Case definition of hip osteoarthritis in epidemiologic studies. J Rheumatol. 1994 Apr;21(4):591–592. [PubMed] [Google Scholar]
  10. Croft P., Cooper C., Wickham C., Coggon D. Defining osteoarthritis of the hip for epidemiologic studies. Am J Epidemiol. 1990 Sep;132(3):514–522. doi: 10.1093/oxfordjournals.aje.a115687. [DOI] [PubMed] [Google Scholar]
  11. Dickersin K., Scherer R., Lefebvre C. Identifying relevant studies for systematic reviews. BMJ. 1994 Nov 12;309(6964):1286–1291. doi: 10.1136/bmj.309.6964.1286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Dickersin Kay. Systematic reviews in epidemiology: why are we so far behind? Int J Epidemiol. 2002 Feb;31(1):6–12. doi: 10.1093/ije/31.1.6. [DOI] [PubMed] [Google Scholar]
  13. Dougados M., Gueguen A., Nguyen M., Berdah L., Lequesne M., Mazieres B., Vignon E. Radiological progression of hip osteoarthritis: definition, risk factors and correlations with clinical status. Ann Rheum Dis. 1996 Jun;55(6):356–362. doi: 10.1136/ard.55.6.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Felson D. T., Anderson J. J. Methodological and statistical approaches to criteria development in rheumatic diseases. Baillieres Clin Rheumatol. 1995 May;9(2):253–266. doi: 10.1016/s0950-3579(05)80189-x. [DOI] [PubMed] [Google Scholar]
  15. Günther K. P., Sun Y. Reliability of radiographic assessment in hip and knee osteoarthritis. Osteoarthritis Cartilage. 1999 Mar;7(2):239–246. doi: 10.1053/joca.1998.0152. [DOI] [PubMed] [Google Scholar]
  16. Hart D. J., Spector T. D. Radiographic criteria for epidemiologic studies of osteoarthritis. J Rheumatol Suppl. 1995 Feb;43:46–48. [PubMed] [Google Scholar]
  17. Hart D. J., Spector T. D. The classification and assessment of osteoarthritis. Baillieres Clin Rheumatol. 1995 May;9(2):407–432. doi: 10.1016/s0950-3579(05)80198-0. [DOI] [PubMed] [Google Scholar]
  18. Haynes R. B., Wilczynski N., McKibbon K. A., Walker C. J., Sinclair J. C. Developing optimal search strategies for detecting clinically sound studies in MEDLINE. J Am Med Inform Assoc. 1994 Nov-Dec;1(6):447–458. doi: 10.1136/jamia.1994.95153434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hirsch R., Fernandes R. J., Pillemer S. R., Hochberg M. C., Lane N. E., Altman R. D., Bloch D. A., Knowler W. C., Bennett P. H. Hip osteoarthritis prevalence estimates by three radiographic scoring systems. Arthritis Rheum. 1998 Feb;41(2):361–368. doi: 10.1002/1529-0131(199802)41:2<361::AID-ART21>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
  20. Ingvarsson T., Hägglund G., Lindberg H., Lohmander L. S. Assessment of primary hip osteoarthritis: comparison of radiographic methods using colon radiographs. Ann Rheum Dis. 2000 Aug;59(8):650–653. doi: 10.1136/ard.59.8.650. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. KELLGREN J. H., LAWRENCE J. S. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494–502. doi: 10.1136/ard.16.4.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Lane N. E., Nevitt M. C., Genant H. K., Hochberg M. C. Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol. 1993 Nov;20(11):1911–1918. [PubMed] [Google Scholar]
  23. MacGregor A. J., Antoniades L., Matson M., Andrew T., Spector T. D. The genetic contribution to radiographic hip osteoarthritis in women: results of a classic twin study. Arthritis Rheum. 2000 Nov;43(11):2410–2416. doi: 10.1002/1529-0131(200011)43:11<2410::AID-ANR6>3.0.CO;2-E. [DOI] [PubMed] [Google Scholar]
  24. Nevitt M. C., Lane N. E., Scott J. C., Hochberg M. C., Pressman A. R., Genant H. K., Cummings S. R. Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum. 1995 Jul;38(7):907–916. doi: 10.1002/art.1780380706. [DOI] [PubMed] [Google Scholar]
  25. Odding E., Valkenburg H. A., Algra D., Vandenouweland F. A., Grobbee D. E., Hofman A. Associations of radiological osteoarthritis of the hip and knee with locomotor disability in the Rotterdam Study. Ann Rheum Dis. 1998 Apr;57(4):203–208. doi: 10.1136/ard.57.4.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Smith R. W., Egger P., Coggon D., Cawley M. I., Cooper C. Osteoarthritis of the hip joint and acetabular dysplasia in women. Ann Rheum Dis. 1995 Mar;54(3):179–181. doi: 10.1136/ard.54.3.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Spector T. D., Cooper C. Radiographic assessment of osteoarthritis in population studies: whither Kellgren and Lawrence? Osteoarthritis Cartilage. 1993 Oct;1(4):203–206. doi: 10.1016/s1063-4584(05)80325-5. [DOI] [PubMed] [Google Scholar]
  28. Sun Y., Günther K. P., Brenner H. Reliability of radiographic grading of osteoarthritis of the hip and knee. Scand J Rheumatol. 1997;26(3):155–165. doi: 10.3109/03009749709065675. [DOI] [PubMed] [Google Scholar]

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