Clinical Rheumatology

, Volume 35, Issue 1, pp 183–189 | Cite as

Associations between pre-operative radiographic osteoarthritis severity and pain and function after total hip replacement

Radiographic OA severity predicts function after THR
  • Michelle M. Dowsey
  • Mandana Nikpour
  • Paul Dieppe
  • Peter F. M. ChoongEmail author
Original Article


Total hip replacement (THR) is an effective procedure for alleviating pain and improving function in majority of patients with end-stage osteoarthritis (OA). Clinically, meaningful improvement in pain and function after surgery is not universal, and the reasons for this are unclear. We investigated whether radiographic OA severity was a determinant of pain and disability experienced by patients after THR. The Harris hip score (HHS) was collected pre-operatively and at 1 and 2 years after primary THR (N = 382). The main independent variable was the modified Kellgren-Lawrence grade, which was assessed from the pre-operative radiographs. The outcome variable was response to surgery at 1 and 2 years. The minimum important difference (MID) in the HHS pain and function scores were used to determine response to surgery. This was based on achieving half the standard deviation in change in scores at 1 year. Regression models were created to assess the relationships between pre-operative x-ray findings and pain and function. Based on the MID, 96.2 and 95.5 % of patients demonstrated an improvement in pain, and 81.2 and 78.3 % of patients demonstrated an improvement in function at 1 and 2 years. Odds ratios for demonstrating an MID in both pain and functions scores for patients with less severe baseline radiographic changes were significantly lower at 1 and 2 years when compared to those with severe radiographic changes. Patients with less severe pre-operative radiographic hip damage are least likely to have substantial gains in terms of pain relief and improved function as a result of a THR.

Level of Evidence: Level III, prognostic study


Osteoarthritis Pain and function Radiographic OA severity Total hip replacement 



Dr Dowsey and Dr Nikpour hold an NHMRC Early Career Australian Clinical Fellowship (APP1035810) and (APP1071735).

Funding source




Supplementary material

10067_2014_2808_MOESM1_ESM.docx (31 kb)
ESM 1 (DOCX 30 kb)


  1. 1.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785PubMedCrossRefGoogle Scholar
  2. 2.
    Dixon T, Shaw M, Ebrahim S, Dieppe P (2004) Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need. Ann Rheum Dis 63(7):825–830PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Dowsey MM, Choong PFM. Predictors of Pain and Function Following Total Joint Replacement. 2013. In: Arthoplasty - Update [Internet]. InTech. Available from:
  4. 4.
    Singh JA, Lewallen D (2010) Predictors of pain and use of pain medications following primary total hip arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years. BMC Musculoskelet Disord 11:90PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Singh JA, Lewallen DG (2010) Predictors of activity limitation and dependence on walking aids after primary total hip arthroplasty. J Am Geriatr Soc 58(12):2387–2393PubMedCrossRefGoogle Scholar
  6. 6.
    Cushnaghan J, Coggon D, Reading I, Croft P, Byng P, Cox K et al (2007) Long-term outcome following total hip arthroplasty: a controlled longitudinal study. Arthritis Rheum 57(8):1375–1380PubMedCrossRefGoogle Scholar
  7. 7.
    Keurentjes JC, Fiocco M, So-Osman C, Onstenk R, Koopman-Van Gemert AW, Poll RG et al (2013) Patients with severe radiographic osteoarthritis have a better prognosis in physical functioning after hip and knee replacement: a cohort-study. PLoS ONE 8(4):e59500PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Valdes AM, Doherty SA, Zhang W, Muir KR, Maciewicz RA, Doherty M (2012) Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty. Semin Arthritis Rheum 41(4):568–575PubMedCrossRefGoogle Scholar
  9. 9.
    Dowsey MM, Nikpour M, Dieppe P, Choong PF (2012) Associations between pre-operative radiographic changes and outcomes after total knee joint replacement for osteoarthritis. Osteoarthr Cartil 20(10):1095–1102PubMedCrossRefGoogle Scholar
  10. 10.
    Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49(4):239–243PubMedCrossRefGoogle Scholar
  11. 11.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755PubMedGoogle Scholar
  12. 12.
    Ware J Jr, Kosinski M, Keller SD (1996) A 12-item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233PubMedCrossRefGoogle Scholar
  13. 13.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Altman RD, Gold GE (2007) Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil 15(Suppl A):A1–A56PubMedCrossRefGoogle Scholar
  15. 15.
    Dieppe PA, Reichenbach S, Williams S, Gregg P, Watt I, Juni P (2005) Assessing bone loss on radiographs of the knee in osteoarthritis: a cross-sectional study. Arthritis Rheum 52(11):3536–3541PubMedCrossRefGoogle Scholar
  16. 16.
    Dieppe P, Judge A, Williams S, Ikwueke I, Guenther KP, Floeren M et al (2009) Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres. BMC Musculoskelet Disord 10:19PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37(5):360–363PubMedGoogle Scholar
  18. 18.
    Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41(5):582–592PubMedGoogle Scholar
  19. 19.
    Hoeksma HL, Van Den Ende CH, Ronday HK, Heering A, Breedveld FC (2003) Comparison of the responsiveness of the Harris hip score with generic measures for hip function in osteoarthritis of the hip. Ann Rheum Dis 62(10):935–938PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86-A(5):963–974PubMedGoogle Scholar
  21. 21.
    Lo GH, McAlindon TE, Niu J, Zhang Y, Beals C, Dabrowski C et al (2009) Bone marrow lesions and joint effusion are strongly and independently associated with weight-bearing pain in knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthr Cartil 17(12):1562–1569PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Ledingham J, Dawson S, Preston B, Milligan G, Doherty M (1993) Radiographic progression of hospital referred osteoarthritis of the hip. Ann Rheum Dis 52(4):263–267PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Singh J, Sloan JA, Johanson NA (2010) Challenges with health-related quality of life assessment in arthroplasty patients: problems and solutions. J Am Acad Orthop Surg 18(2):72–82PubMedPubMedCentralGoogle Scholar
  24. 24.
    Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ et al (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg (Br) 89(8):1010–1014CrossRefGoogle Scholar
  25. 25.
    Achten J, Parsons NR, Edlin RP, Griffin DR, Costa ML (2010) A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint. BMC Musculoskelet Disord 11:8PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2014

Authors and Affiliations

  • Michelle M. Dowsey
    • 1
  • Mandana Nikpour
    • 2
    • 3
  • Paul Dieppe
    • 4
  • Peter F. M. Choong
    • 1
    Email author
  1. 1.Department of Orthopaedics and The University of Melbourne Department of SurgerySt. Vincent’s Hospital MelbourneFitzroyAustralia
  2. 2.The University of Melbourne Department of MedicineSt. Vincent’s Academic CentreMelbourneAustralia
  3. 3.Department of RheumatologySt. Vincent’s Hospital MelbourneMelbourneAustralia
  4. 4.University of Exeter Medical SchoolExeterUK

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