Study finds 12% rate of THA within 3 years after initial complaints of osteoarthritis pain

In a 3- to 6-year evaluation, the predictive factors for THA included age, morning stiffness and pain in the groin and medial thigh.

Approximately 12% of patients who see a general practitioner due to hip pain from osteoarthritis undergo total hip arthroplasty within 3 years, according to a study by researchers in The Netherlands.

Annet M. Lievense, MD, and colleagues at Erasmus Medical Center in Rotterdam investigated the progression of osteoarthritis (OA) and rates of total hip arthroplasty (THA) among patients with hip pain. They published their results in Arthritis Care & Research.

The study included 224 patients aged 50 years and older who had been evaluated by their general practitioners in 1996 due to complaints of hip pain. Researchers questioned patients about their pain severity and general health, performed physical exams, and obtained pelvic radiographs and hip sonograms.

Investigators performed follow-up evaluations 3 years later, which included in-person interviews regarding patients' progression of hip pain and whether they underwent THA. They also assessed patients' OA using the WOMAC Osteoarthritis Index.

Comparable follow-up evaluations were again completed the subsequent 3 years using a mailed survey.

The researchers found that, at 3-years follow-up, the disease had progressed in 29 patients (15%) and 23 patients (12%) had undergone THA.

At 6-years follow-up, the disease had progressed in 45 patients (28%) and 36 patients (22%) had undergone THA, according to the study.

They reported the prognostic variables for a THA after 3 and 6 years were: age 60 years and older; morning stiffness and pain in the groin/medial thigh; decreased extension/adduction; painful internal rotation; a body mass index of 30 kg/m² or less; and a Kellgren/Lawrence grade of 2 or higher.

The researchers noted that while an earlier analysis of their data did not indicate an association between age and progression of hip pain, the current study did find the two were connected, according to a press release announcing the study results.

"The difference might be attributed to selection for surgery: if a patient is relatively young, physicians tend to postpone surgery to avoid the risk of re-surgery after 10 to 20 years," the authors wrote.

"With information obtained from history taking, physical examination and radiology, we are now better able to identify persons who are at high risk for progression of hip OA," they reported. "This can be helpful not only to inform patients more precisely about the course of their hip pain, but also for future clinical trials."

For more information:
Lievense AM, Koes BW, Verhaar JAN, et al. Prognosis of hip pain in general practice: A prospective follow-up study. Arthritis Care Res. 2007;57:1368-1374.