Abstract
Cite this article: Bone Joint Res 2023;12(5):309–310.
The outcomes following total hip arthroplasty (THA) in patients with early osteoarthritis (OA) are less predictable than in severe disease.1-4 We wanted to assess the factors that are associated with successful outcome.
We compared 70 patients with early OA (Kellgren and Lawrence (KL) grades 0 to 2) with 200 patients with advanced OA (KL grades 3 and 4). Oxford Hip Scores (OHS),5,6 EuroQol five-dimension questionnaire (EQ-5D), and EuroQol-visual analogue scale (EQ-VAS) scores were analyzed preoperatively and one year postoperatively. A subgroup analysis was performed for those with early OA to identify factors (clinical and radiological) associated with a successful THA – defined as a postoperative OHS ≥ 42; the so-called ‘patient-acceptable symptom state’.7
Patients undergoing THA with early OA were significantly younger (61 vs 66 years; p = 0.004), however no differences in BMI, American Society of Anesthesiologists (ASA),8 or sex were noted. After confounders were adjusted for, there were no differences in preoperative OHS or EQ-5D scores between the two groups, however postoperative function scores were significantly lower in the early OA group. In the early OA group, EQ-VAS was significantly lower preoperatively and also postoperatively. No differences in complication, revision, or readmission rates were observed.
Only 16/70 (23%) patients with early OA had a successful THA (OHS ≥ 42). In the radiological analysis (n = 38 with preoperative CT or MRI scans), subchondral cysts were seen more commonly in the successful THA group compared with the unsuccessful group (92% vs 58%; p = 0.036). A narrower joint space width on CT or MRI was associated with a successful THA, as was the absence of a postoperative complication.
We recommend obtaining a preoperative CT or MRI scan in patients with early radiological OA, and if this fails to demonstrate subchondral cysts then a THA is unlikely to provide a satisfactory outcome.
References
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Author contributions
M. Sharrock: Data curation, Formal analysis, Methodology, Writing – original draft.
T. Board: Conceptualization, Methodology, Supervision, Writing – review & editing.
Funding statement
The authors did not receive any financial or material support for the research, authorship, and/or publication of this article.
© 2023 Author(s) et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
