Radiographic stage of osteoarthritis or sex of the patient does not predict one year outcome after total hip arthroplasty

Abstract

Objective-To investigate whether patients with severe radiographic osteoarthritis (OA) have a diVerent outcome at one year after total hip replacement than patients with moderate radiographic OA. To investigate sex related diVerences in preoperative radiographic and self reported status and in postoperative outcome. Methods-184 patients (96 women) with a mean age at surgery of 71.4 years (50-92), with primary OA of the hip were investigated preoperatively and six and 12 months postoperatively with two self administered questionnaires, SF-36 and WOMAC. The radiographs were evaluated by two independent radiologists using an atlas. Minimal joint space narrowing, osteophytes, cysts, sclerosis, and deformity were assessed. A summary grade 0-3 was made, based on joint space, where 3 is severe OA. The reference population for SF-36 consisted of 2901 subjects matched for age and sex from the general Swedish population. Results-162 patients fulfilled the study criteria. 113 had grade 3, 47 grade 2, and two grade 1 radiographic OA. There was no diVerence in preoperative or postoperative pain and physical impairment between patients with moderate and severe radiographic OA. There were no sex related diVerences in preoperative radiographic status, or in postoperative outcome. Neither were any diVerences in preoperative radiographic status of OA found in patients with previous total hip replacement of the contralateral hip, compared with those who had not been operated on before. All patients, regardless of preoperative radiographic OA stage, showed significant postoperative improvement and at one year achieved a health related quality of life similar to that of the reference group. Conclusion-The severity of radiographic changes indicating OA often weighs heavily in the surgeon's decision to perform a total hip replacement. Yet, the findings of this study emphasise that the preoperative radiographic stage of OA has no correlation with the postoperative outcome after one year. Furthermore, this study failed to detect any sex related diVerences in preoperative radiographic and self reported status or in postoperative outcome of hip replacement.

Women Demonstrate More Pain and Worse Function Before THA but Comparable Results 12 Months After Surgery

“…First, we did not obtain any objective measures of the severity of hip arthritis to see whether lower baseline PROM scores were matched by more severe radiographic findings in women. Some previous studies suggest that the grade of radiographic OA is unrelated to self-rated pain and function (WOMAC scores), at least for moderate to severe OA [31], whereas others show a relationship between radiographic and clinical variables [5,10]. Second, this study was conducted in Switzerland; differences between countries in their healthcare systems or social structure might govern whether gender differences in baseline PROMs are observed.…”

“…Similarly, gender may have an influence on the interpretation of patientrated outcomes when judging the success of surgery. Many [18,30,32] but not all [31] studies have shown that women have higher pain levels and worse function when they present for surgery for the treatment of degenerative musculoskeletal conditions. However, it is unclear whether this necessarily translates into a worse overall outcome after surgery or a lower level of satisfaction with treatment.…”

Factors influencing surgeons' decisions in the indication for total joint replacement in hip osteoarthritis in real life

“…According to certain studies, the relationship between radiographic findings and pain and function is weak (18 -20). It has been suggested that the preoperative radiographic grade does not influence the clinical outcome 1 year after THA (20). Consequently, it has been proposed that symptoms, and not the degree of radiographic change, should provide the indication for surgery (6,20).…”

The impact of non-traumatic hip and knee disorders on health-related quality of life as measured with the SF-36 or SF-12. A systematic review

“…Consequently, we refrained from computing pooled z-scores for these studies. We pooled two studies concerning patients with knee or hip OA in clinical settings (data from hip and knee patients were not presented separately in these studies) [29,30], three studies on patients with knee OA in clinical settings [31][32][33], two studies on patients with knee or hip OA, admitted or scheduled for TKA or THA (data from hip and knee patients were also not presented separately in these studies) [34,35], 19 studies on patients with knee OA admitted or scheduled for TKA [25,26,28,33,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] and 23 studies on patients with hip OA admitted or scheduled for THA [26,28,36,[39][40][41][42][43][44][45][46][48][49][50][51][52][53][54][55]…”

“…Of the 40 studies we included, one study concerned patients in the general population [61] (223 patients), three studies concerned community living elderly [27,62,63] (in total 133,358 patients), one study concerned patients in a primary care setting [64] (195 patients), five studies concerned patients in clinical settings [29][30][31][32][33] (in total 1407 patients) and thirty studies concerned patients with OA admitted or scheduled for total arthroplasty (in total 5191 patients admitted for TKA [25,26,28,33,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]65] and 4236 patients admitted for THA [26,28,36,[39][40][41][42][43][44][45][46][48][49][50][51][52][53]…”