Abstract
BackgroundEvidence on prognostic factors associated with progression to total hip replacement (THR) in hip osteoarthritis (OA) is for the most patient- and disease-specific characteristics either conflicting or inconclusive. Therefore, the objectives of this study of participants with hip OA enrolled in a structured program of supervised education and exercise therapy were to describe the rate of THR and to identify prognostic factors for receiving THR within the following 2 years.MethodsParticipants aged ≥ 45 years with hip OA enrolled in Good Life with osteoArthritis in Denmark (GLA:D®) from July 2014 to March 2017 were included. Potential prognostic factors included demographic and disease-specific baseline characteristics and measures of physical activity and quality of life (QoL). Information on THR was retrieved from The Danish National Patient Registry. A multivariable Cox proportional hazards model was developed.ResultsOf 3657 included participants, 30% received a THR within 2 years. Of the 100 participants already wait-listed for THR, 60% had the procedure. Of 22 candidate prognostic factors, 14 were statistically significant for receiving THR. Factors associated with a faster rate of THR included being “male” (HR 1.43), having “self-reported radiographic hip OA” (HR 2.32), being “wait-listed for THR” (HR 2.17), and having a higher “pain intensity” (HR 1.01). In contrast, faster “walking speed” (HR 0.64), better “hip-related QoL” (HR 0.98), and having “three or more comorbidities” (HR 0.62) were predictive of a slower rate of THR.ConclusionDuring the 2-year follow-up period, 30% of the cohort received a THR. Notably, 40% of those wait-listed for THR when entering the program did not receive THR within 2 years. A number of baseline prognostic factors for receiving THR were identified.
Highlights
Evidence on prognostic factors associated with progression to total hip replacement (THR) in hip osteoarthritis (OA) is for the most patient- and disease-specific characteristics either conflicting or inconclusive
A recent systematic review [6] summarized the evidence on patient- and disease-specific factors associated with progression in patients with hip OA and found strong evidence that more pronounced radiographic changes were associated with faster progression to THR
The time period for data collection was determined by the presence of variables in the database and the possibility to pair with registry data from The Danish National Patient Registry that was available up until March 1, 2019
Summary
Evidence on prognostic factors associated with progression to total hip replacement (THR) in hip osteoarthritis (OA) is for the most patient- and disease-specific characteristics either conflicting or inconclusive. Clinical guidelines universally recommend patient education and exercise therapy as first-line treatments for hip OA [3, 4]. Total hip replacement surgery (THR) should only be considered for patients who experience joint symptoms (pain, stiffness, and reduced function) with a substantial impact on their quality of life (QoL) and who are not responding well to non-surgical treatments [5]. A recent systematic review [6] summarized the evidence on patient- and disease-specific factors associated with progression in patients with hip OA and found strong evidence that more pronounced radiographic changes were associated with faster progression to THR. Knowledge gained from such research can benefit patients because it helps clinicians better inform patients about their prognosis and guide treatment decisions
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