Worse Patient-Reported Outcomes and Spino-Pelvic Parameters After Total Hip Arthroplasty for Rapidly Progressive Osteoarthritis of the Hip Compared to Osteoarthritis: A Propensity-Matched Cohort Study

Yoshinori Okamoto; Hitoshi Wakama; Kaito Nakamura; Takashi Ishitani; Shuhei Otsuki; Masashi Neo

doi:10.1016/j.arth.2024.04.016

Worse Patient-Reported Outcomes and Spino-Pelvic Parameters After Total Hip Arthroplasty for Rapidly Progressive Osteoarthritis of the Hip Compared to Osteoarthritis: A Propensity-Matched Cohort Study

J Arthroplasty. 2024 Apr 10:S0883-5403(24)00328-0. doi: 10.1016/j.arth.2024.04.016. Online ahead of print.

Authors

Yoshinori Okamoto¹, Hitoshi Wakama², Kaito Nakamura², Takashi Ishitani², Shuhei Otsuki², Masashi Neo²

Affiliations

¹ Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, Saiseikai Ibaraki Hospital, Ibaraki, Japan.
² Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.

PMID: 38608844
DOI: 10.1016/j.arth.2024.04.016

Abstract

Background: This study aimed to assess the association between the disease process of hip osteoarthritis and total hip arthroplasty (THA) outcomes; this is a critical issue, as rapid progression has been postulated to be responsible for patient dissatisfaction after THA.

Methods: This retrospective case-control study included 255 patients who underwent THA and completed a mean follow-up duration of 42.1 months (range, 24.0 to 77.0). We classified patients into those who had (n = 26) and did not have (n = 229) rapidly progressive osteoarthritis of the hip (RPOA), defined as a narrowing rate of joint space ≥ 2 mm yearly or a ≥ 50% loss within 12 months, excluding any other cause of a destructive arthropathy. Propensity score-matched cohorts for age, sex, body mass index, and spino-pelvic measures were created, and the outcomes were compared between the 2 groups.

Results: After successfully matching RPOA (n = 25) and non-RPOA patients (n = 50), there were significant differences in minimum clinically important difference (P = .009 for European Quality of Life 5-Dimension, and P < .001 for low back pain), patient acceptable symptom state (P = .015 for European Quality of Life 5-Dimension, and P < .001 for Hip Disability and Osteoarthritis Outcome Score Joint Replacement score), patient satisfaction (P = .028), and T1 pelvic angle as an indicator of global sagittal spinal deformity (P = .017). There was a correlation between T1 pelvic angle and low back pain in the RPOA group (R = 0.628, P < .001).

Conclusions: Patients who exhibited RPOA before undergoing THA showed worse patient-reported outcomes compared with those who did not have rapid progression. Our study highlights the critical role of the disease process in influencing THA outcomes, advocating for a paradigm shift toward more meticulous preoperative evaluations, including global spinal deformity, standardized diagnostic criteria, and tailored interventions.

Keywords: T1 pelvic angle; low back pain; patient-reported outcomes; rapidly progressive osteoarthritis; spino-pelvic alignment; total hip arthroplasty.