An automated workflow based on hip shape improves personalized risk prediction for hip osteoarthritis in the CHECK study.

W. P. Gielis, H. H. Weinans, Paco M J Welsing, W. E. van Spil, Rintje Agricola, Timothy Cootes, Pim A. de Jong, Claudia Lindner

Research output: Contribution to journalArticlepeer-review


Objective To design an automated workflow for hip radiographs focused on joint shape and tests its prognostic value for future hip osteoarthritis.
Design We used baseline and eight-year follow-up data from 1002 participants of the CHECK-study. The primary outcome was definite radiographic hip osteoarthritis (rHOA) (Kellgren-Lawrence grade ≥2 or joint replacement) at eight-year follow-up. We designed a method to automatically segment the hip joint from radiographs. Subsequently, we applied machine learning algorithms (elastic net with automated parameter optimization) to provide the Shape-Score, a single value describing the risk for future rHOA based solely on joint shape. We built and internally validated prediction models using baseline demographics, physical examination, and radiologists scores and tested the added prognostic value of the Shape-Score using Area-Under-the-Curve (AUC). Missing data was imputed by multiple imputation by chained equations. Only hips with pain in the corresponding leg were included.
Results 84% were female, mean age was 56 (±5.1) years, mean BMI 26.3 (±4.2). Of 1044 hips with pain at baseline and complete follow-up, 143 showed radiographic osteoarthritis and 42 were replaced. 91.5% of the hips had follow-up data available. The Shape-Score was a significant predictor of rHOA (odds ratio per decimal increase 5.21, 95%- CI (3.74 – 7.24)). The prediction model using demographics, physical examination, and radiologists scores demonstrated an AUC of 0.795, 95%-CI (0.757 – 0.834). After addition of the Shape-Score the AUC rose to 0.864, 95%-CI (0.833 – 0.895).
Conclusions Our Shape-Score, automatically derived from radiographs using a novel machine learning workflow, may strongly improve risk prediction in hip osteoarthritis.
Original languageEnglish
Pages (from-to)62-70
Number of pages9
JournalOsteoarthritis and cartilage / OARS, Osteoarthritis Research Society
Issue number1
Early online date8 Oct 2019
Publication statusPublished - 2020


  • Epidemiology
  • Hip osteoarthritis
  • Imaging
  • Statistical shape analysis


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