A new strategy for the selection of patients with hip osteoarthritis to avoid inappropriate total hip replacement based on imaging and clinical characteristics.

Background: Total hip replacement (THR) is extremely common and generally results in excellent patient satisfaction. However, 36% of patients with hip osteoarthritis who undergo THR reportedly experience long-term postoperative pain. Furthermore, only 20% of patients attempt exercise before surgery, despite the recommendation for 3 to 6 months of conservative treatment before surgery. Despite these facts, the number of THRs performed annually is currently increasing.

Objectives: To propose and discuss a new strategy based on clinical and radiological characteristics for selecting candidates for Pericapsular Soft Tissue and Pelvic Realignment (PSTP-R) therapies to avoid inappropriate THR.

Methods: The PubMed electronic database was searched to identify publications reporting data from clinical studies on the diagnosis and treatment of osteoarthritis in humans published between 1995 and 2023. This narrative review summarizes the findings of these previous studies.

Results: A previous study reported that PSTP-R therapy comprising pelvic realignment, muscle strengthening, and stretching was effective for patients with a Harris Hip Score (HHS) below 60 points, even those with complete loss of cartilage on radiography. A post hoc study showed that the risk of discontinuation of PSTP-R therapy increased with increasing frequency of pain in the buttock at baseline. Cartilage loss was not a risk factor for withdrawal from PSTP-R therapy.

Conclusion: Patients should be better informed regarding the benefits of THR and the possibility of persistent postoperative pain. If the patient has complete loss of cartilage on radiography but no buttock pain, PSTP-R therapy might improve their pain and avoid THR.