Machine-learning derived acetabular dysplasia and cam morphology are features of severe hip osteoarthritis: findings from UK Biobank

Monika R Frysz; Benjamin G Faber; Raja Ebsim; Fiona R Saunders; Claudia Lindner; Jenny S Gregory; Richard M Aspden; Nicholas Harvey; Timothy Cootes; Jonathan H Tobias

doi:10.1002/jbmr.4649

Machine-learning derived acetabular dysplasia and cam morphology are features of severe hip osteoarthritis: findings from UK Biobank

Monika R Frysz^*, Benjamin G Faber, Raja Ebsim, Fiona R Saunders, Claudia Lindner, Jenny S Gregory, Richard M Aspden, Nicholas Harvey, Timothy Cootes, Jonathan H Tobias

^*Corresponding author for this work

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Abstract

The contribution of shape changes to hip osteoarthritis (HOA) remains unclear, as is the extent to which these vary according to HOA severity. In the present study, we used statistical shape modelling (SSM) to evaluate relationships between hip shape and HOA of different severities using UK Biobank DXA images. We performed a cross-sectional study in individuals with left hip DXA scans. Statistical shape modelling (SSM) was used to quantify hip shape. Radiographic HOA (rHOA) was classified using osteophyte size and number, and joint space narrowing. HOA outcomes ranged in severity from moderate (grade 2) or severe (grade ≥3) rHOA, hospital diagnosed HOA, and subsequent total hip replacement (THR). Confounder-adjusted logistic regression between the top ten hip shape modes (HSMs) and OA outcomes was performed. Further models adjusted for alpha angle (AA) and lateral centre-edge angle (LCEA), reflecting acetabular dysplasia and cam morphology respectively. Composite HSM figures were produced combining HSMs associated with separate OA outcomes. A total of 40,311 individuals were included (mean 63.7 years, 47.8% male), of whom 5.7% had grade 2 rHOA, 1.7% grade ≥3 rHOA, 1.3% hospital diagnosed HOA, and 0.6% underwent THR. Composite HSM figures for grade 2 rHOA revealed femoral neck widening, increased acetabular coverage, and enlarged lesser and greater trochanters. In contrast, grade ≥3 rHOA, hospital diagnosed HOA and THR were suggestive of cam morphology and reduced acetabular coverage. Associations between HSMs depicting cam morphology and reduced acetabular coverage and more severe HOA were attenuated by AA and LCEA adjustment, respectively. Relationships between hip shape and HOA differed according to severity. Notably, cam morphology and acetabular dysplasia were features of severe HOA, but unrelated to moderate disease, suggesting possible prognostic utility.

Original language	English
Pages (from-to)	1720-1732
Number of pages	13
Journal	Journal of Bone and Mineral Research
Volume	37
Issue number	9
Early online date	10 Jul 2022
DOIs	https://doi.org/10.1002/jbmr.4649
Publication status	Published - 1 Sept 2022

Bibliographical note

Funding Information:
The authors thank Dr Martin Williams, Consultant Musculoskeletal Radiologist North Bristol NHS Trust, who provided substantial training and expertise in osteophyte assessment on DXA images. This research has been conducted using the UK Biobank Resource (application number 17295). RE, MF, and FRS are supported and this work is funded by a Wellcome Trust collaborative award (reference number 209233). BGF is supported by a Medical Research Council (MRC) clinical research training fellowship (MR/S021280/1). CL was funded by the MRC, UK (MR/S00405X/1), as well as a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (223267/Z/21/Z). NCH acknowledges support from the MRC and NIHR Southampton Biomedical Research Centre, University of Southampton, and University Hospital Southampton. This research was funded in whole, or in part, by the Wellcome Trust (grant number 223267/Z/21/Z). For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. Authors’ roles: Conceptualization: CL, TC, and JT. Funding acquisition: CL, TC, JT, RE, JSG, and NCH. Data curation: MF, BGF, RE, FRS. Methodology: RE, TC, CL, and JSG. Formal analysis: MF. Project administration: MF and JT. All authors were involved in drafting the article and/or revising it critically for important intellectual content, and all authors approved the final version to be published. MF had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding Information:
RE, MF, and FRS are supported and this work is funded by a Wellcome Trust collaborative award (reference number 209233). BGF is supported by a Medical Research Council (MRC) clinical research training fellowship (MR/S021280/1). CL was funded by the MRC, UK (MR/S00405X/1), as well as a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (223267/Z/21/Z). NCH acknowledges support from the MRC and NIHR Southampton Biomedical Research Centre, University of Southampton, and University Hospital Southampton. This research was funded in whole, or in part, by the Wellcome Trust (grant number 223267/Z/21/Z).

Publisher Copyright:
© 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Keywords

OSTEOARTHRITIS
Hip shape
SSM
cam morphology
acetabular dysplasia

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Frysz, M. R., Faber, B. G., Ebsim, R., Saunders, F. R., Lindner, C., Gregory, J. S., Aspden, R. M., Harvey, N., Cootes, T., & Tobias, J. H. (2022). Machine-learning derived acetabular dysplasia and cam morphology are features of severe hip osteoarthritis: findings from UK Biobank. Journal of Bone and Mineral Research, 37(9), 1720-1732. https://doi.org/10.1002/jbmr.4649

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title = "Machine-learning derived acetabular dysplasia and cam morphology are features of severe hip osteoarthritis: findings from UK Biobank",

abstract = "The contribution of shape changes to hip osteoarthritis (HOA) remains unclear, as is the extent to which these vary according to HOA severity. In the present study, we used statistical shape modelling (SSM) to evaluate relationships between hip shape and HOA of different severities using UK Biobank DXA images. We performed a cross-sectional study in individuals with left hip DXA scans. Statistical shape modelling (SSM) was used to quantify hip shape. Radiographic HOA (rHOA) was classified using osteophyte size and number, and joint space narrowing. HOA outcomes ranged in severity from moderate (grade 2) or severe (grade ≥3) rHOA, hospital diagnosed HOA, and subsequent total hip replacement (THR). Confounder-adjusted logistic regression between the top ten hip shape modes (HSMs) and OA outcomes was performed. Further models adjusted for alpha angle (AA) and lateral centre-edge angle (LCEA), reflecting acetabular dysplasia and cam morphology respectively. Composite HSM figures were produced combining HSMs associated with separate OA outcomes. A total of 40,311 individuals were included (mean 63.7 years, 47.8% male), of whom 5.7% had grade 2 rHOA, 1.7% grade ≥3 rHOA, 1.3% hospital diagnosed HOA, and 0.6% underwent THR. Composite HSM figures for grade 2 rHOA revealed femoral neck widening, increased acetabular coverage, and enlarged lesser and greater trochanters. In contrast, grade ≥3 rHOA, hospital diagnosed HOA and THR were suggestive of cam morphology and reduced acetabular coverage. Associations between HSMs depicting cam morphology and reduced acetabular coverage and more severe HOA were attenuated by AA and LCEA adjustment, respectively. Relationships between hip shape and HOA differed according to severity. Notably, cam morphology and acetabular dysplasia were features of severe HOA, but unrelated to moderate disease, suggesting possible prognostic utility.",

keywords = "OSTEOARTHRITIS, Hip shape, SSM, cam morphology, acetabular dysplasia",

author = "Frysz, {Monika R} and Faber, {Benjamin G} and Raja Ebsim and Saunders, {Fiona R} and Claudia Lindner and Gregory, {Jenny S} and Aspden, {Richard M} and Nicholas Harvey and Timothy Cootes and Tobias, {Jonathan H}",

note = "Funding Information: The authors thank Dr Martin Williams, Consultant Musculoskeletal Radiologist North Bristol NHS Trust, who provided substantial training and expertise in osteophyte assessment on DXA images. This research has been conducted using the UK Biobank Resource (application number 17295). RE, MF, and FRS are supported and this work is funded by a Wellcome Trust collaborative award (reference number 209233). BGF is supported by a Medical Research Council (MRC) clinical research training fellowship (MR/S021280/1). CL was funded by the MRC, UK (MR/S00405X/1), as well as a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (223267/Z/21/Z). NCH acknowledges support from the MRC and NIHR Southampton Biomedical Research Centre, University of Southampton, and University Hospital Southampton. This research was funded in whole, or in part, by the Wellcome Trust (grant number 223267/Z/21/Z). For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. Authors{\textquoteright} roles: Conceptualization: CL, TC, and JT. Funding acquisition: CL, TC, JT, RE, JSG, and NCH. Data curation: MF, BGF, RE, FRS. Methodology: RE, TC, CL, and JSG. Formal analysis: MF. Project administration: MF and JT. All authors were involved in drafting the article and/or revising it critically for important intellectual content, and all authors approved the final version to be published. MF had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: RE, MF, and FRS are supported and this work is funded by a Wellcome Trust collaborative award (reference number 209233). BGF is supported by a Medical Research Council (MRC) clinical research training fellowship (MR/S021280/1). CL was funded by the MRC, UK (MR/S00405X/1), as well as a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (223267/Z/21/Z). NCH acknowledges support from the MRC and NIHR Southampton Biomedical Research Centre, University of Southampton, and University Hospital Southampton. This research was funded in whole, or in part, by the Wellcome Trust (grant number 223267/Z/21/Z). Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).",

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doi = "10.1002/jbmr.4649",

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T1 - Machine-learning derived acetabular dysplasia and cam morphology are features of severe hip osteoarthritis

T2 - findings from UK Biobank

AU - Frysz, Monika R

AU - Faber, Benjamin G

AU - Ebsim, Raja

AU - Saunders, Fiona R

AU - Lindner, Claudia

AU - Gregory, Jenny S

AU - Aspden, Richard M

AU - Harvey, Nicholas

AU - Cootes, Timothy

AU - Tobias, Jonathan H

N1 - Funding Information: The authors thank Dr Martin Williams, Consultant Musculoskeletal Radiologist North Bristol NHS Trust, who provided substantial training and expertise in osteophyte assessment on DXA images. This research has been conducted using the UK Biobank Resource (application number 17295). RE, MF, and FRS are supported and this work is funded by a Wellcome Trust collaborative award (reference number 209233). BGF is supported by a Medical Research Council (MRC) clinical research training fellowship (MR/S021280/1). CL was funded by the MRC, UK (MR/S00405X/1), as well as a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (223267/Z/21/Z). NCH acknowledges support from the MRC and NIHR Southampton Biomedical Research Centre, University of Southampton, and University Hospital Southampton. This research was funded in whole, or in part, by the Wellcome Trust (grant number 223267/Z/21/Z). For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. Authors’ roles: Conceptualization: CL, TC, and JT. Funding acquisition: CL, TC, JT, RE, JSG, and NCH. Data curation: MF, BGF, RE, FRS. Methodology: RE, TC, CL, and JSG. Formal analysis: MF. Project administration: MF and JT. All authors were involved in drafting the article and/or revising it critically for important intellectual content, and all authors approved the final version to be published. MF had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: RE, MF, and FRS are supported and this work is funded by a Wellcome Trust collaborative award (reference number 209233). BGF is supported by a Medical Research Council (MRC) clinical research training fellowship (MR/S021280/1). CL was funded by the MRC, UK (MR/S00405X/1), as well as a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (223267/Z/21/Z). NCH acknowledges support from the MRC and NIHR Southampton Biomedical Research Centre, University of Southampton, and University Hospital Southampton. This research was funded in whole, or in part, by the Wellcome Trust (grant number 223267/Z/21/Z). Publisher Copyright: © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

PY - 2022/9/1

Y1 - 2022/9/1

N2 - The contribution of shape changes to hip osteoarthritis (HOA) remains unclear, as is the extent to which these vary according to HOA severity. In the present study, we used statistical shape modelling (SSM) to evaluate relationships between hip shape and HOA of different severities using UK Biobank DXA images. We performed a cross-sectional study in individuals with left hip DXA scans. Statistical shape modelling (SSM) was used to quantify hip shape. Radiographic HOA (rHOA) was classified using osteophyte size and number, and joint space narrowing. HOA outcomes ranged in severity from moderate (grade 2) or severe (grade ≥3) rHOA, hospital diagnosed HOA, and subsequent total hip replacement (THR). Confounder-adjusted logistic regression between the top ten hip shape modes (HSMs) and OA outcomes was performed. Further models adjusted for alpha angle (AA) and lateral centre-edge angle (LCEA), reflecting acetabular dysplasia and cam morphology respectively. Composite HSM figures were produced combining HSMs associated with separate OA outcomes. A total of 40,311 individuals were included (mean 63.7 years, 47.8% male), of whom 5.7% had grade 2 rHOA, 1.7% grade ≥3 rHOA, 1.3% hospital diagnosed HOA, and 0.6% underwent THR. Composite HSM figures for grade 2 rHOA revealed femoral neck widening, increased acetabular coverage, and enlarged lesser and greater trochanters. In contrast, grade ≥3 rHOA, hospital diagnosed HOA and THR were suggestive of cam morphology and reduced acetabular coverage. Associations between HSMs depicting cam morphology and reduced acetabular coverage and more severe HOA were attenuated by AA and LCEA adjustment, respectively. Relationships between hip shape and HOA differed according to severity. Notably, cam morphology and acetabular dysplasia were features of severe HOA, but unrelated to moderate disease, suggesting possible prognostic utility.

AB - The contribution of shape changes to hip osteoarthritis (HOA) remains unclear, as is the extent to which these vary according to HOA severity. In the present study, we used statistical shape modelling (SSM) to evaluate relationships between hip shape and HOA of different severities using UK Biobank DXA images. We performed a cross-sectional study in individuals with left hip DXA scans. Statistical shape modelling (SSM) was used to quantify hip shape. Radiographic HOA (rHOA) was classified using osteophyte size and number, and joint space narrowing. HOA outcomes ranged in severity from moderate (grade 2) or severe (grade ≥3) rHOA, hospital diagnosed HOA, and subsequent total hip replacement (THR). Confounder-adjusted logistic regression between the top ten hip shape modes (HSMs) and OA outcomes was performed. Further models adjusted for alpha angle (AA) and lateral centre-edge angle (LCEA), reflecting acetabular dysplasia and cam morphology respectively. Composite HSM figures were produced combining HSMs associated with separate OA outcomes. A total of 40,311 individuals were included (mean 63.7 years, 47.8% male), of whom 5.7% had grade 2 rHOA, 1.7% grade ≥3 rHOA, 1.3% hospital diagnosed HOA, and 0.6% underwent THR. Composite HSM figures for grade 2 rHOA revealed femoral neck widening, increased acetabular coverage, and enlarged lesser and greater trochanters. In contrast, grade ≥3 rHOA, hospital diagnosed HOA and THR were suggestive of cam morphology and reduced acetabular coverage. Associations between HSMs depicting cam morphology and reduced acetabular coverage and more severe HOA were attenuated by AA and LCEA adjustment, respectively. Relationships between hip shape and HOA differed according to severity. Notably, cam morphology and acetabular dysplasia were features of severe HOA, but unrelated to moderate disease, suggesting possible prognostic utility.

KW - OSTEOARTHRITIS

KW - Hip shape

KW - SSM

KW - cam morphology

KW - acetabular dysplasia

U2 - 10.1002/jbmr.4649

DO - 10.1002/jbmr.4649

M3 - Article (Academic Journal)

C2 - 35811326

SN - 0884-0431

VL - 37

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JO - Journal of Bone and Mineral Research

JF - Journal of Bone and Mineral Research

IS - 9

ER -

Machine-learning derived acetabular dysplasia and cam morphology are features of severe hip osteoarthritis: findings from UK Biobank

Abstract

Bibliographical note

Keywords

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