Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis

Oct 21, 2015Acta orthopaedica

Hip replacement results are linked to arthritis severity seen on X-rays before surgery, but knee replacement results are not

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Abstract

In total hip arthroplasty (THA) patients, radiographic severity of osteoarthritis (OA) is associated with improved functioning, pain relief, and health-related quality of life one year post-surgery.

In THA patients, 74% had severe OA, while 26% had mild OA before surgery.
Improvements in activities of daily living, pain, and symptoms were linked to the severity of OA in THA patients.
No associations were found between preoperative OA severity and outcomes in total knee arthroplasty (TKA) patients.
Changes in health-related quality of life as measured by the SF36 physical component summary scale were related to OA severity in THA but not in TKA.

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BACKGROUND AND PURPOSE: There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA.

PATIENTS AND METHODS: This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0-2) and severe OA (KL 3-4) using a multivariate linear regression model.

RESULTS: Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS "Activities of daily living", "Pain", and "Symptoms", and SF36 physical component summary ("PCS") scale. In TKA, we found no such associations.

INTERPRETATION: The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA.

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Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis

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