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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

Abstract

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

Keywords

Osteoarthritis Pain and function Radiographic OA severity Total hip replacement 

Notes

Acknowledgments

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

Funding source

Nil

Disclosures

None

Supplementary material

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

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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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