Does total hip arthroplasty benefit patients with minimal radiological osteoarthritis?

Listen to Simon and Amy discuss the paper 'Does total hip arthroplasty benefit patients with minimal radiological osteoarthritis?' published in the March 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper 'Does total hip arthroplasty benefit patients with minimal radiological osteoarthritis?', published in March 2025 by K Logishetty and colleagues. I am Simon, and I'm joined by my co-host, Amy.

Hello everyone. This paper explores a really intriguing question, whether total hip arthroplasty or THA provides any benefit to patients who show minimal radiological signs of osteoarthritis? It's a nuanced issue that's very important for both patients and clinicians to understand. So let's delve into it Simon.

The study aimed to assess the outcomes of patients undergoing THA despite having no or minimal signs of osteoarthritis on their radiographs. These patients were generally younger and did not exhibit the severe degenerative changes on radiographs, commonly seen in older THA candidates. Instead, many of the patients had morphological abnormalities, including hip [00:01:00] dysplasia and femoral acetabular impingement.

Some patients had unexplained hip pain refractory to conservative management. The researchers also aimed to identify any patient comorbidities or imaging findings that could predict outcomes. Finally, they compared these outcomes to the expected results of standard THA for hip osteoarthritis.

To achieve this, they conducted a retrospective observational study using data from a single-centre at University College London Hospital.

They examined a series of 1,925 total hip arthroplasties performed between January 2006 and December 2021. After applying some exclusion criteria, they analyzed data from 107 hips in 102 patients. Their primary outcome measure was the Oxford Hip Score with several secondary measures like patient satisfaction and the UCLA activity scale.

An interesting aspect was the use of diagnostic hip injections as a decision aid. All patients [00:02:00] underwent these injections to confirm that their pain was indeed originating from the hip joint itself. Patients who experienced relief from the injection were more likely to benefit from total hip arthroplasty.

Precisely. Almost 90% of patients reported high levels of satisfaction with the surgery and felt better compared to their preoperative state. However, the study found that these patients had lower postoperative function than typical THA patients found in international registries. For instance, only 33% of these patients achieved what's called a patient-acceptable symptom state on the Oxford Hip Score, which is a threshold of 42 points. This is lower compared to typical THA patients.

Another key finding was the impact of comorbidities. Patients with conditions like chronic pain syndrome or hypermobility had significantly worse outcomes. For example, those with chronic pain had Oxford Hip Scores that were about six points lower on average.

Conversely, patients with subchondral cysts or joint space narrowing on their [00:03:00] preoperative CT scans or chondral damage on MRI scans had higher functional outcomes and were more satisfied with their surgeries. Yes, and this underscores the importance of imaging. The study suggests that low-dose CT imaging in particular, should be used to aid in the decision making process for THA in patients with minimal radiological osteoarthritis. CT scans provide a clearer picture and help identify features like subchondral cysts, and joint space narrowing that aren't visible on regular radiographs.

Another takeaway is the paper's recommendation for a nuanced approach to patient selection. Radiographs alone may not tell the whole story, and there are clearly some patients who benefit from having a hip arthroplasty despite not having severe arthritis.

However, not all patients with minimal radiological signs of osteoarthritis will benefit equally from total hip arthroplasty. The role of a diagnostic hip injection combined with detailed imaging seems crucial in making the best therapeutic decisions. It's evident from this study [00:04:00] that while younger patients with minimal radiological signs can benefit from THA, their outcomes aren't as predictably positive as those seen in patients with more advanced osteoarthritis.

It highlights the need for personalized evaluation and suggests that some patients, particularly those with chronic pain or hypermobility, may require additional support and realistic expectations.

Quite right, Amy. To summarize the study underscores the complexity of decision-making for total hip arthroplasty in young patients with minimal radiological osteoarthritis. It's not merely about the presence of pain. The findings suggests that careful consideration of imaging results and patient-specific factors is essential. Low-dose CT imaging and diagnostic hip injections play a crucial role, A multidisciplinary approach and shared decision making are key.

Absolutely Simon and with that, we wrap up today's episode. Remember, the goal is to tailor medical interventions to the specific needs of the patient, keeping in mind their unique clinical [00:05:00] presentation and comorbidities. Thanks for tuning into AI Talks with Bone & Joint. Join us next time when we delve into another fascinating topic in orthopaedic research.

Thanks Amy, and thank you all for listening.