A recent study evaluated the effectiveness of total hip arthroplasty in patients with hip pain and minimal radiographic signs of osteoarthritis.

In the study, published in Bone & Joint Open, researchers analyzed 107 total hip arthroplasty (THA) cases at the University College London Hospital and found that while most patients reported symptomatic improvement and high satisfaction following surgery, only 33.6% of them achieved an Oxford Hip Score (OHS) of 42 or higher—the threshold considered a patient-acceptable symptom state. The median postoperative OHS was 34 (interquartile range [IQR] = 28–42), which was lower than the typical postoperative range of 40 to 43 reported in national joint registries.

The cohort had a median age of 41 years (range = 18–73), and all of the patients had minimal osteoarthritis (OA) defined as Tönnis grade 0 or 1. The mean follow-up was 6 years (standard deviation = 3.1). Secondary outcomes included a median EQ-visual analogue scale (EQ-VAS) score of 72.5 (IQR = 50.5–80.3) and a UCLA activity scale score of 5.6 (IQR = 4.4–8.0). In total, 89% of patients reported that their hip felt “better” following surgery and that they would choose to undergo the procedure again.

Outcomes varied based on imaging findings and comorbidities. Patients with subchondral cysts or joint space narrowing identified on preoperative computed tomography (CT) had higher median OHS. In contrast, patients with chronic pain syndrome or hypermobility had lower OHS scores, with chronic pain associated with a 5.1-point decrease and hypermobility with a 5.7-point decrease.

All of the patients underwent diagnostic hip injections prior to surgery to confirm the hip joint as the source of pain. Patients with inflammatory arthritis, osteonecrosis, prior trauma, or infection were excluded.

“Despite high satisfaction levels, patients undergoing THA with minimal or no radiological OA had lower postoperative function than typical [patients undergoing] THA,” said lead study author Kartik Logishetty, MBBS, PhD, of the University College London Hospital, and his colleagues.

The researchers recommend the use of low-dose CT and diagnostic injections to guide patient selection. Further research is needed to compare outcomes between THA and hip preservation procedures in patients with minimal OA.

Full disclosures and funding details are available in the original publication.