{"title":"Which factors are associated with a successful outcome following total hip arthroplasty in patients with early radiographic osteoarthritis?","authors":"Martin Sharrock, Tim N Board","doi":"10.1177/11207000241235892","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>It is unclear which factors are associated with a successful total hip arthroplasty (THA) in patients with early radiographic osteoarthritis (OA).</p><p><strong>Methods: </strong>70 patients with early OA (Kellgren and Lawrence [KL] grades 0-2) who underwent THA were compared with 200 patients with advanced OA (KL grades 3-4). Outcomes were Oxford Hip Scores (OHS), EQ-5D and EQ-VAS scores; compared preoperatively with 1 year postoperatively. We investigated which clinical and radiographic (plain x-ray, CT, MRI) features predicted successful THA (postoperative OHS ⩾42).</p><p><strong>Results: </strong>The early OA group were significantly younger (61 vs. 66 years; [<i>p</i> <i>=</i> 0.0035). There were no significant differences in BMI, ASA grade or gender. After adjusting for confounders, the advanced OA group had a significantly greater percentage of possible change (PoPC) in OHS (75.8% vs. 50.4%; <i>p</i> <i><</i> 0.0001) and improvement in EQ-5D (0.151 vs. 0.002; <i>p</i> <i><</i> 0.0001). There were no significant differences in complication, revision or readmission rates. In the early OA group, 16/70 (22.9%) patients had a 'successful' THA. Patients who had a 'successful' THA were significantly more likely to have subchondral cysts on CT/MRI (91.7% vs. 57.7%; <i>p</i> <i>=</i> 0.0362). The presence of cysts on CT/MRI was associated with a significantly greater PoPC in OHS (61.6% vs. 38.2%; <i>p</i> <i>=</i> 0.0353). The combination of cysts and joint space width <1 mm was associated with a PoPC of 68%.</p><p><strong>Conclusions: </strong>THA in patients with early OA (KL grades 0-2) on plain radiographs should be indicated with caution. We advocate preoperative cross-sectional imaging in these patients. In the absence of cysts on CT/MRI, a THA seems unlikely to provide a satisfactory outcome.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"HIP International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/11207000241235892","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/11 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: It is unclear which factors are associated with a successful total hip arthroplasty (THA) in patients with early radiographic osteoarthritis (OA).
Methods: 70 patients with early OA (Kellgren and Lawrence [KL] grades 0-2) who underwent THA were compared with 200 patients with advanced OA (KL grades 3-4). Outcomes were Oxford Hip Scores (OHS), EQ-5D and EQ-VAS scores; compared preoperatively with 1 year postoperatively. We investigated which clinical and radiographic (plain x-ray, CT, MRI) features predicted successful THA (postoperative OHS ⩾42).
Results: The early OA group were significantly younger (61 vs. 66 years; [p= 0.0035). There were no significant differences in BMI, ASA grade or gender. After adjusting for confounders, the advanced OA group had a significantly greater percentage of possible change (PoPC) in OHS (75.8% vs. 50.4%; p< 0.0001) and improvement in EQ-5D (0.151 vs. 0.002; p< 0.0001). There were no significant differences in complication, revision or readmission rates. In the early OA group, 16/70 (22.9%) patients had a 'successful' THA. Patients who had a 'successful' THA were significantly more likely to have subchondral cysts on CT/MRI (91.7% vs. 57.7%; p= 0.0362). The presence of cysts on CT/MRI was associated with a significantly greater PoPC in OHS (61.6% vs. 38.2%; p= 0.0353). The combination of cysts and joint space width <1 mm was associated with a PoPC of 68%.
Conclusions: THA in patients with early OA (KL grades 0-2) on plain radiographs should be indicated with caution. We advocate preoperative cross-sectional imaging in these patients. In the absence of cysts on CT/MRI, a THA seems unlikely to provide a satisfactory outcome.
期刊介绍:
HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice.
The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit.
HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are:
• Biomaterials
• Biomechanics
• Conservative Hip Surgery
• Paediatrics
• Primary and Revision Hip Arthroplasty
• Traumatology