Patient-reported outcomes among age-matched hip resurfacing and total hip arthroplasty: an analysis of 622 patients with a minimum 2-year follow-up.

Abstract

Aim: The purpose of this study was to investigate differences in patient-reported outcome measures (PROMs) among patients who underwent THA in comparison to Birmingham hip resurfacing (BHR) for the treatment of osteoarthritis.

Methods: A prospective cohort of 1414 patients who underwent BHR (n = 707) or THA (n = 707) for the treatment of primary osteoarthritis in a single healthcare system between July 2015 and December 2017 were included and propensity score matched on age. Differences between groups in the Hip disability and Osteoarthritis Outcome Score (HOOS) pain subscale, HOOS-Physical Function Shortform (PS), and the University of California at Los Angeles (UCLA) activity score at 2 years follow-up were evaluated. Minimal clinically important differences (MCID) were based on previous studies.

Results: Of the total 622 patients (THA, n = 311; BHR, n = 311) who completed the 2-year follow-up, BHR patients reported less pain (2-year HOOS pain: BHR, 100; THA, 95; p < 0.001), higher function (2-year HOOS PS: BHR, 95.4; THA, 91.2; p < 0.001), and greater activity levels (2-year UCLA activity: BHR, 7.5; THA, 6; p < 0.001) compared to THA patients. After adjusting for demographic variables, no significant difference in estimated median HOOS pain scores was found between cohorts. BHR patients exhibited significantly higher median HOOS-PS scores (HOOS-PS score difference: 2.5, 95% CI, 0.38-5.4; p = 0.03) and higher median UCLA activity scores (UCLA activity score difference: 0.79, 95% CI, 0.33-1.24; p < 0.001) compared to THA patients. No differences were observed in the proportion of patients achieving MCID thresholds in all PROMs between groups.

Conclusion: BHR and THA have both been shown to significantly ameliorate pain and enhance functional capacity in patients with end-stage osteoarthritis. Interestingly, at the 2-year postoperative follow-up, BHR patients exhibited higher activity levels and improved physical function compared to those who underwent THA; however, the extent of this improvement may not reach clinical relevance.