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Study aims to prevent hip pain

Five-year project examines effects of activity and a common hip deformity

BY determining the cause of hip pain, those behind a collaborative research project hope to find a means of changing the way hip pain is treated, as well as preventing osteoarthritis, a progressive joint disease, in future generations.

Entitled Investigations of Mobility, Physical Activity, and Knowledge in Hip Pain (IMPAKT-HiP), the project is being funded by the Canadian Institutes of Health Research. The $2.5 million study targets a mix of ethnicities - Caucasian, Chinese and Aboriginal - and is being undertaken by the Vancouver-based Arthritis Research Centre of Canada, in partnership with S.U.C.C.E.S.S., a social service agency with a strong focus on multiculturalism.

Researchers are interested in looking at whether hip pain is caused by certain physical activities, a common hip joint deformity called femoroacetabular impingement (FAI) or a combination of the two.

For those with FAI, a condition involving bumps either on the hip bone or socket, certain physical activities can result in increased friction in the joint and potentially cause damage and pain. Due to their requirement of repetitive hip flexion, examples of activities that could result in discomfort for those with FAI include skating, jogging, soccer, skiing, horseback riding and cycling.

"Through this project, we can actually look at the relationship between this deformity, different types of activity and different ethnic populations and try to unravel the cause of osteoarthritis," says Dr. Linda Li, co-investigator of IMPAKT-HiP. Li is also an associate professor at the University of British Columbia and a research scientist at the Arthritis Research Centre of Canada.

A five-year project, recruitment for participants is underway, with anticipated completion in 2015.

Osteoarthritis (OA), the most common form of arthritis, affects one in 10 Canadians, most commonly in the joints of the hips, knees, hands and spine. According to statistics from the IMPAKT-HiP research team, hip osteoarthritis is responsible for more than 90 per cent of hip replacements performed across the country at a cost of $10,000-$12,000 each to the health-care system.

"For a disease that is so common, the amount of attention paid to it in the research community is relatively small," says Li.

What sets IMPAKT-HiP apart from much of the bone and joint disease research being conducted across the country is its focus on osteoarthritis prevention, rather than treatment. For example, some studies are looking at surgical interventions at the disease's later stages (i.e. which type of prosthesis is the best and lasts the longest). Others are looking at how lifestyle intervention, like weight management or exercise, can help manage osteoarthritis.

"What we're looking at is upstream from the management question," says Li. "Assuming we're looking at a population that doesn't have osteoarthritis right now and we have an idea what may cause it, can we confirm this theory is correct first of all? And then down the road, we can look at what are the interventions that can actually prevent osteoarthritis for the generations to come."

Recruitment is currently underway in B.C. for the Caucasian (500) and Chinese (200) populations via a telephone recruitment agency and are so far on target. Researchers plan to begin seeking participation via door-to-door canvassing from Vancouver Island First Nations members (400) in spring 2013.

Those three ethnic groups were chosen based on current findings that suggest of the three populations, Chinese has the least incidence of hip osteoarthritis, then Caucasian, and Aboriginal has the highest incidence.

"If we know the prevalence of osteoarthritis is different in all three populations and if FAI is the predominant cause of osteoarthritis in the hip, then we should see that same pattern in the three different populations," says Li, of the FAI prevalence study she's overseeing, serving as project leader, under the umbrella of IMPAKT-HiP.

Researchers are looking for participants between the ages of 20 and 50 years old.

"We're looking for people who may have hip pain and with or without FAI. And then we can study them before they develop osteoarthritis in the hip," says Li.

Participants are asked to complete a questionnaire about their general health, and their degree of physical activity over the course of their lifetime. Volunteers also undergo a physical assessment of their hip, including an X-ray, to determine whether they have FAI.

Some of the Caucasian participants will be asked to undergo an MRI of their hip, one looking at bone structure while they're lying down, and the other, thanks to a special unit at Vancouver General Hospital, which will take images of their hip while they complete certain movements, i.e. flexing the joint, kicking a soccer ball, etc.

Results of this study are hoped to be able to enable doctors, physiotherapists and other health professionals treating patients with FAI to recommend physical activities they can engage in and what adjustments, if any, would be advisable, so they can stay active, and not cause further harm.

A strong advocate for IMPAKT-HiP is West Vancouver resident Sheila Kerr, 57, who knows firsthand the challenges of hip osteoarthritis.

"I look forward to seeing the results of this study," she says. "I wish it had taken place years ago, as perhaps it could have influenced some of my choices in physical activities and prevented or slowed the progression of my joint problems."

While Kerr maintains an active life, using an exercise bike, kayaking and walking, she had to stop skiing, hiking and playing tennis as a result of her diagnosis with osteoarthritis. In addition, she had to miss out on a recent trip with her husband to walk the Camino de Santiago.

"You end up limiting your activities. You choose activities to preserve your joint," she says.

"Those of us with osteoarthritis have to find a balance - enough of the right exercise to keep mobile and build strong muscles to protect our joints, while avoiding joint-loading type activities that may lead to the worsening of our OA," she adds.

Kerr has a family history of osteoarthritis and a number of her relatives have experienced extreme pain, hip replacement and disability.

"I am completely aware of what the road looks like if you don't take care of yourself early and you don't change these things," she says.

In addition to her personal interest in osteoarthritis, as well as her background as a physiotherapist, Kerr has recently joined the Arthritis Research Centre of Canada's consumer advisory board and serves as its co-chairwoman.

"It's a group of people with arthritis who bring their experience of living with arthritis to the research cycle," she says.

In the context of IMPAKT-HiP, her role relates to what she calls "knowledge translation." She and her fellow board members are working to raise awareness of osteoarthritis and to prove that it's "not a normal part of aging." She's also trying to let people know about the study itself and in the future, will help disseminate its findings.

Kerr encourages anyone who receives a call to be part of the study to agree to participate. "We encourage people to say yes because we need more research to get better answers to our questions," she says.

"Good information becomes part of your health-care decision-making and in order to have good information, we need more research," she adds.

For more information on IMPAKT-HiP and the Arthritis Research Centre of Canada, visit