Association between preoperative radiographic osteoarthritis severity and patient-reported outcomes after total hip arthroplasty: a systematic review and meta-analysis.
Junya Yoshitani, Joseph Dulleston, Amir Reza Rafati Fard et al.
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In 30 seconds
This systematic review and meta-analysis examined whether preoperative radiographic osteoarthritis (OA) severity is associated with patient-reported outcomes after primary total hip arthroplasty. It included 18 observational studies involving 9,235 patients, comparing moderate with severe radiographic OA. Severe OA was associated with modestly better postoperative function (SMD -0.34; 95% CI -0.62 to -0.07) and health-related quality of life (SMD -0.33; 95% CI -0.54 to -0.11); pain outcomes did not differ significantly. Substantial heterogeneity limits confidence in these estimates.
Key findings
- Severe versus moderate OA was associated with better function after surgery (SMD -0.34; 95% CI -0.62 to -0.07; I² = 83%).
- Health-related quality of life modestly favoured severe OA (SMD -0.33; 95% CI -0.54 to -0.11; I² = 70%).
- Postoperative pain did not differ significantly between severity groups (SMD -0.14; 95% CI -0.51 to 0.22; I² = 79%).
- Patients with moderate OA had lower odds of a clinically meaningful response (OR 0.51; 95% CI 0.36-0.72); complication rates showed no statistically detectable difference.
Why it matters
Radiographic severity may help contextualise expected patient-reported benefit after hip replacement, but the findings suggest it is not a reliable predictor of pain relief. The modest functional and quality-of-life differences, alongside substantial heterogeneity, underscore the importance of interpreting imaging in the broader clinical context rather than treating severity alone as a measure of likely outcome.
What to keep in mind
All included studies were observational, and substantial heterogeneity limits confidence in the pooled estimates.