Does arthritis in other joints and spine influence the 1-year outcome of total hip replacement? A prospective multicenter cohort study (EUROHIP) measuring the influence of musculoskeletal morbidity

Journal article

Background
Whilst arthritis in other affected joints and back pain is known to lead to worse outcomes following total hip replacement surgery, these risk factors have not previously been operationalized as a musculoskeletal morbidity profile. The aim of this study was to measure the influence of other joints and spine (as grades of musculoskeletal morbidity) on the 1-year outcome of primary total hip replacement.

Methods
The European Collaborative Database of Cost and Practice Patterns of Total Hip Replacement study consists of 1,327 patients receiving primary THR for osteoarthritis across 20 European orthopedic centers. The primary outcome was the responder rate for THR at 12-months as measured by the relative effect per patient (REPP score), calculated for each patient using the total WOMAC score. The primary predictor of interest was combinations of arthritis of large joints and spine grouped into four musculoskeletal morbidity (MSM) grades: 1 (single-joint), 2 (multi-joints), 3 (single-joint and spine), 4 (multi-joints and spine). Confounders adjusted for were: age, sex, body mass index, living alone, years of hip pain, ASA grade, anxiety/depression, pre-operative WOMAC subscales.

Results
845 patients were included for this analysis with complete 12-month follow-up WOMAC scores. The mean age was 65.7 years and 55.2% were female. Increasing MSM grade was associated with worse outcomes of surgery, where the proportion of patients responding to THR were: 254 (92.4%) MSM grade 1, 272 (87.2%) MSM grade 2, 46 (80.7%) MSM grade 3, 142 (74.4%) MSM grade 4. This was confirmed in adjusted logistic regression models: MSM grade 4 vs. 1 relative risk ratio (RRR) 0.82 95% confidence interval (CI) (0.75, 0.90); MSM grade 3 vs. 1 OR 0.87 95%CI (0.77, 0.99); MSM grade 2 vs. 1 OR 0.95 95%CI (0.89, 1.00).

Conclusions
Other joints and spine measured as musculoskeletal morbidity have a strong influence on the 1-year outcome after THR. The effect size was large in comparison to other risk factors. Even so, the majority of patients in MSM grade 4 can still profit from surgery (>75% response to surgery).

Authors: Huber, J; Dieppe, P; Dreinhoefer, K; Günther, K; Judge, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Lippincott, Williams & Wilkins
• Journal: Journal of Bone and Joint Surgery: American Volume
• Volume: 99
• Issue: 17
• Pages: 1428–1437
• Publication date: 2017-09-06
• Acceptance date: 2017-03-23
• DOI: 10.2106/JBJS.16.01040
• EISSN: 1535-1386
• ISSN: 0021-9355