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What are the differences in the recovery of physical function and clinical score between patients with steroid-related osteonecrosis of the femoral head and hip osteoarthritis undergoing total hip arthroplasty? A propensity score–matched study

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Abstract

Purpose

Steroid-related osteonecrosis of the femoral head (ONFH), arising from steroid administration for underlying diseases, represents a unique pathology for total hip arthroplasty (THA) and typically affects a younger demographic compared to osteoarthritis (OA). Given the significant age-related differences, this study aims to employ propensity score matching to align patient backgrounds between these two diseases and compare physical function. Additionally, our objective is to scrutinize the patterns of clinical score recovery over the course of one year following THA.

Methods

Using propensity score matching, 29 patients each with steroid-related ONFH and OA were selected. Muscle strength (hip abductor and knee extensor) were assessed before and after THA. Additionally, recovery of the Harris Hip Score (HHS) and Oxford Hip Score (OHS) up to one year postoperatively was analyzed.

Results

The steroid-related ONFH group exhibited gender bias and significantly younger age compared to the OA group. Propensity score matching achieved balanced patient backgrounds. Physical function showed trends of lower hip abduction and knee extensor strength on the operative side in the steroid-related ONFH group. Notably, nonoperative knee extensor strength decreased significantly after matching. HHS and OHS were poor in steroid-related ONFH up to three months postoperatively but recovered after six months.

Conclusions

Patients with steroid-related ONFH experience positive outcomes in clinical score following THA. Propensity score matching effectively identified muscle weakness on both operative and nonoperative sides, highlighting its utility in comparative analyses.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available.

Abbreviations

BMI:

Body mass index

HHS:

Harris Hip Score

OA:

Osteoarthritis

OHS:

Oxford Hip Score

ONFH:

Osteonecrosis of the femoral head

THA:

Total hip arthroplasty

UCLA:

University of California Los Angeles

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Acknowledgements

We would like to thank all the medical staff, including physicians, nurses, laboratory technicians, and therapists, as well as the patients and their family members for their contributions to this study.

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Authors and Affiliations

  1. Department of Rehabilitation, Kyoto University Hospital, Kyoto, Japan

    Ryota Hamada, Takumi Kawano, Masanobu Murao, Manabu Nankaku, Ryosuke Ikeguchi & Shuichi Matsuda

  2. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Yaichiro Okuzu, Toshiyuki Kawai, Yutaka Kuroda, Ryosuke Ikeguchi & Shuichi Matsuda

  3. Rehabilitation Unit of Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan

    Ryota Hamada

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  1. Ryota Hamada
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Contributions

RH, TK, MM, and MN designed the study, reviewed and analyzed the data, and wrote the paper. MN interpreted the data and revised the manuscript. YO, YK, TK, RI, and SM contributed to the data collection and critiqued the manuscript. RH has full access to the data in the study and accepts final responsibility for the decision to publish.

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Correspondence to Ryota Hamada.

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Hamada, R., Kawano, T., Murao, M. et al. What are the differences in the recovery of physical function and clinical score between patients with steroid-related osteonecrosis of the femoral head and hip osteoarthritis undergoing total hip arthroplasty? A propensity score–matched study. International Orthopaedics (SICOT) 48, 1233–1239 (2024). https://doi.org/10.1007/s00264-024-06128-1

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