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a Department
of Orthopaedics, Halmstad County Hospital, Sweden, b Department of Radiology, Halmstad
County Hospital, Sweden, c Department of Orthopaedics, Lund University
Hospital, Sweden, d Department
of Orthopaedics, Helsingborg County Hospital, Sweden
Correspondence to: Dr A-K Nilsdotter, Department of Orthopaedics, Halmstad County Hospital, SE-30233 Halmstad, Sweden anna.nilsdotter{at}adept.se
Accepted for publication 12 July 2000
OBJECTIVE
To
investigate whether patients with severe radiographic osteoarthritis
(OA) have a different outcome at one year after total hip replacement
than patients with moderate radiographic OA. To investigate sex related
differences in preoperative radiographic and self reported status and
in postoperative outcome.
METHODS184 patients
(96 women) with a mean age at surgery of 71.4 years (50-92), with
primary OA of the hip were investigated preoperatively and six and 12 months postoperatively with two self administered questionnaires, SF-36
and WOMAC. The radiographs were evaluated by two independent
radiologists using an atlas. Minimal joint space narrowing,
osteophytes, cysts, sclerosis, and deformity were assessed. A summary
grade 0-3 was made, based on joint space, where 3 is severe OA. The
reference population for SF-36 consisted of 2901 subjects matched for
age and sex from the general Swedish population.
RESULTS162 patients
fulfilled the study criteria. 113 had grade 3, 47 grade 2, and two
grade 1 radiographic OA. There was no difference in preoperative or
postoperative pain and physical impairment between patients with
moderate and severe radiographic OA. There were no sex related
differences in preoperative radiographic status, or in postoperative
outcome. Neither were any differences in preoperative radiographic
status of OA found in patients with previous total hip replacement of
the contralateral hip, compared with those who had not been operated on
before. All patients, regardless of preoperative radiographic OA stage,
showed significant postoperative improvement and at one year achieved a
health related quality of life similar to that of the reference group.
CONCLUSIONThe
severity of radiographic changes indicating OA often weighs heavily in
the surgeon's decision to perform a total hip replacement. Yet, the
findings of this study emphasise that the preoperative radiographic
stage of OA has no correlation with the postoperative outcome after one
year. Furthermore, this study failed to detect any sex related
differences in preoperative radiographic and self reported status or in
postoperative outcome of hip replacement.
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