Short summary

The PhD project has the following purpose:

1. Investigate the reproducibility of ultrasound examination of the hip and the diagnostic accuracy of ultrasound scan compared to X-ray findings in patients with hip osteoarthritis.
2. Investigate and describe ultrasound characteristics in patients with clinical hip osteoarthritis.
3. Investigate the predictive value of ultrasound examination in patients with clinical hip osteoarthritis, who undergo an evidence-based patient education and training program (GLA:D®).

Rationale

Osteoarthritis is characterized by progressive destruction of joint cartilage, bone tissue changes, osteophyte formation, joint inflammation and loss of normal joint function. In symptomatic osteoarthritis, patients present themselves with activity related pain, impaired function and joint stiffness.

The diagnostic imaging standard for osteoarthritis is conventional X-rays. However, there is little correlation between hip related pain and radiological signs of osteoarthritis, and conventional X-rays are unable to visualize inflammatory components and changes in the tissue around the joints associated with osteoarthritis.

There are scientific studies indicating that ultrasound findings are correlated with clinical parameters in patients with osteoarthritis. However, as with X-ray examination, ultrasound examination also reveals changes in asymptomatic persons.

Ultrasound examination is increasingly used in both the primary and secondary sectors in Denmark to investigate a wide range of disorders of the musculoskeletal system and the modality is able to visualize both some structural changes in the articular bone (osteophytes) and inflammatory changes in the joints and the tissue around.

The most frequent pathological findings in ultrasound examination in patients with hip osteoarthritis are synovial proliferation, joint joints, osteophytes and bursitis.

In order to optimize the diagnostic imaging in patients with osteoarthritis, there is increasing interest in validating musculoskeletal ultrasound imaging in rheumatic diseases as well as standardizing scanning techniques and definitions of abnormalities. However, there is generally a lack of hip joint studies and ultrasound scans are criticized for having a high degree of examinator dependence and lack of validation.

A recent literature review on the clinimetrics of ultrasound pathologies in osteoarthritis includes only 5 articles referred to the hip, and the latest study investigating inter- and intraoperator compliance in ultrasound examination in patients with hip osteoarthritis was performed in 2006. This study used only one single investigator to perform the scans and the conformity was calculated by the two different ultrasound experts describing the images based on film sequences after the actual study was performed. Although this is a recognized method to perform reproducibility studies in ultrasound, one has removed the main source of uncertainty - namely the operator. Therefore, it is relevant to perform the reproducibility study with two investigators, which both scan the participants. In addition, the results from the reproducibility study will form the scientific basis for the subsequent scanning procedure in the following study, where we will apply the scanning procedure for patients with hip arthritis who undergo treatment in GLA: D®.

There is no curative treatment for osteoarthritis, but there is evidence that exercise can reduce the nuisance caused by osteoarthritis and prolong the time from symptom debut to the need for surgery. National and international guidelines recommend that treatment of patients with knee and hip osteoarthritis starts with patient education, exercise and weight loss (if necessary).

Good life with osteoarthritis in Denmark (GLA: D®) represents such evidence-based treatment of knee and hip osteoarthritis consisting of patient education and neuromuscular training. At the same time, GLA: D® is an electronic register with a unique opportunity to follow the patients with from the first symptoms and evaluate the effect of treatment. GLA: D® has existed as a national registry since January 29, 2013 and has nearly 30,000 registered patients, of whom approx. 25% is patients with hip osteoarthritis.

Description of the cohort

Adults (age >39) with clinical hip osteoarthritis. 

Data and biological material

Questionnaire data and data om findning in diagnostic imaging (ultrasound and x-rays).

Collaborating researchers and departments

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark

• Professor Jan Hartvigsen

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark

• Erik Poulsen, Post. Doc., PhD.

Diagnostic Center, Silkeborg Hospital  and Odense University Hospital

• Ulrich Fredberg, PhD

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark and chief of research in the Department of Physiotherapy and Occupational Therapy, Næstved, Slagelse and Ringsted Hospital 

• Lektor Søren Thorgaard Skou, PhD 

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark

• Bodil Al-Mashhadi Arnbak, PhD