"Exploring the Impact of Preoperative Radiographic Arthritis Severity on Total Hip Arthroplasty Outcomes" Can patients with less radiographic hip disease still do well after a THA?

Abstract

Background As total hip arthroplasty (THA) indications continue to expand and longevity increases, it is important to understand the outcomes in different patient populations. Younger, more active patients are electing to proceed with THA with differing severity of disease. We aimed to investigate patient reported outcome measures (PROMs) in patients who underwent THA with less severe radiographic hip arthrosis.Methods Pre- and post-operative PROMs and radiographic data (joint-space width, Tonnis grade) for patients undergoing THA between 9/16/2016 and 10/21/2021 by a single surgeon were collected. Baseline Tonnis grades were stratified, and PROMs, including Harris Hip Score (HHS), Hip Outcome Score (HOS), and Short-Form-12 Scale (SF-12), were compared pre- and post-operatively.Results Four-hundred and sixty-two hips underwent analysis. Pre-operative HHS following THA were ​​46.6 ± 11.9, 47.5 ± 11.4, 44.4 ± 9.6, and 42.1 ± 10.7 for Tonnis grades 0 (n = 27), 1 (n = 56), 2 (n = 73), and 3 (n = 306), respectively; while post-operative HHS were 86.4 ± 7.8, 88.4 ± 7.7, 89.5 ± 4.4, and 88.7 ± 5.4 Higher postoperative HOS scores were seen in Tonnis grade 0 and 1, when compared to Tonnis grades 2, and 3 (49.1 ± 27.9, and 50.1 ± 20.8 vs. 47.0 ± 22.2, and 44.0 ± 22.2, respectively; p = 0.003), however, no statistical difference was seen in mean difference HOS (p = 0.447). For SF-12, the mean improvement in order of increasing Tonnis grades was 16.7 ± 48.7, 9.2 ± 38.3, 6.6 ± 43.4, and 14.9 ± 45.2 with no statistical significance observed (p = 0.565).Conclusion In patients undergoing THA, post-operative HHS scores are similar regardless of baseline radiographic severity. Post-operative change in HOS and SF-12 scales was consistently higher across all baseline Tonnis grades prior to THA, while mean change remained comparable. These findings suggest although preoperative radiographic data aids in the evaluation of patients with hip pain, the severity of findings should not determine surgical candidacy. This study challenges radiographic severity for THA eligibility and adds to THA literature for those with less severe radiographic findings.