Evaluation of general health status in total hip arthroplasty patients, 30- year cohort study

Evaluation of general health status in total hip arthroplasty patients, 30- year cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of general health status in total hip arthroplasty patients, 30- year cohort study Virginia Elizabeth Macias Mosquera, Luis David Marcial Barba, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6895475/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Total hip arthroplasty (THA) is the primary treatment for severe joint damage and represents a significant surgical advancement of the century. This study aims to evaluate the long-term health-related quality of life (HRQoL) of THA patients, based on a remarkable follow-up period of 30 years after surgery. Methods: This is a retrospective comparative cohort study in Latin American population. The cohort includes all THA performed between January 1, 1990, and December 31, 2020. A total of 458 patients from this database were evaluated, with a follow-up period of 30 years. Our population showed a high frequency of patients with rheumatoid pathologies (RP); therefore, we performed a simple random sampling to balance the number of cases for comparison between the two study groups: the osteoarthritis (OA) group and the RP group. For functional assessment, the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used. At the same time, pain was assessed using a Numeric Rating Scale (NRS). THA survival was evaluated using the Kaplan-Meier method and to assess HRQoL with the Short Form 36 Health Survey (SF-36). A p-value of less than 0.05 was considered statistically significant. Results : THA positively affects pain relief, physical function, mental health, and social participation. To achieve an excellent postoperative outcome, it is essential to optimize both the physical and emotional aspects before and after surgery. The ultimate goal is to enhance patients' quality of life. Conclusions : THA should be complemented by physical and psychosocial optimization strategies both before and after surgery, incorporating a multidimensional assessment and extended follow-up. Trial registration: Not applicable, this study is an observational retrospective cohort; no prospective registration was required. hip arthroplasty functionality physical health well-being satisfaction survival Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Total hip arthroplasty (THA) is the preferred treatment for patients with severe joint damage. Often referred to as the "surgery of the century," it helps restore mobility and alleviate pain. The most common reason for performing THA is osteoarthritis (OA), followed by rheumatic pathologies (RP), which involve inflammation and significant joint involvement ( 1 , 2 , 3 ). In patients suffering from RP, medical treatment typically includes pharmacological options such as non-steroidal anti-inflammatory drugs, glucocorticoids, immunosuppressants, and disease-modifying antirheumatic drugs. Continuous physical rehabilitation therapy is also crucial. An important percentage of patients who receive glucocorticoid treatments report developing avascular necrosis of the femoral head ( 4 , 5 , 6 , 7 ). The functionality of patients diagnosed with OA has been extensively documented in the literature. In contrast, patients with restrictions, such as those with RP, are crucial for restoring mobility and improving quality of life ( 27 , 28 , 29 , 30 ). The Short Form 36 Health Survey (SF-36) is a tool used to evaluate quality of life. Developed in 1980 as part of the Medical Outcomes Study (MOS), this survey is employed in medical research to assess health-related quality of life (HRQoL) in an "objective" and multidimensional manner. The SF-36 evaluates several dimensions, including physical functioning, limitations due to physical health, limitations due to emotional problems, energy and fatigue, emotional well-being, social functioning, pain, and general health, according to the research of Liu et al. in 2019 ( 14 ). However, its application in THA for assessing patient satisfaction has been limited in arthroplasty procedures ( 19 ). Concerning THA-related survival, studies involving patients with RP and younger individuals have reported an average survival rate of approximately 10 to 15 years, which tends to decrease over time ( 9 , 10 , 11 ). We will conduct a 30-year longitudinal evaluation of health-related quality of life following primary THA. Our goal is to quantify long-term changes in function, pain, and overall well-being and to determine whether patients with RP experience greater improvements than those with primary OA across physical, mental, and social domains. We hypothesize that when the systemic disease is adequately controlled, RP recipients will achieve larger and more sustained gains than their OA counterparts. Few studies have tracked these dimensions related to THA. Methods This study is a retrospective comparative cohort analysis conducted at the Hip and Knee Joint Reconstruction Service of a specialized referral hospital in Mexico City. The cohort includes all total THA performed from January 1, 1990, to December 31, 2020. Our primary data sources consisted of institutional electronic medical records and a departmental arthroplasty database, specifically focusing on a Latin American population. We utilized the comprehensive database from the Hip and Knee Joint Reconstruction Service, which contains detailed information about patients who have undergone THA. A total of 458 patients from this database were evaluated, with a follow-up period of 30 years. Our population showed a high prevalence of patients with RP, and we employed a simple random sampling, stratified by diagnosis, selecting 50 procedures for primary OA and 50 for RP, ensuring a 1:1 ratio. Individual matching was not utilized to maintain true clinical heterogeneity. All surgeries were performed by three hip reconstruction surgeons who served throughout the entire study period to minimize variability in operative techniques. We employed simple random sampling and conducted a loss analysis to minimize selection bias. To reduce information bias, we performed double data entry and conducted a reconciliation process. Additionally, we adjusted the log-rank and Cox models for factors such as age, gender, BMI, and comorbidities to account for potential confounding variables. The eligibility criteria for participant selection were as follows: ( 1 ) participants must be at least 18 years old, ( 2 ) must have a Kellgren–Lawrence grade IV coxarthrosis, and ( 3 ) must have undergone primary THA at our institution during the study period. Exclusion criteria included death during follow-up, having the surgery performed at another institution, or refusal to participate in the study. Out of 458 eligible patients, 30 died for reasons unrelated to THA, 28 had their surgery performed elsewhere, and eight declined to participate. All data were collected by two independent reviewers using a standardized collection form, and any discrepancies were resolved by consensus. The information gathered for analysis included exposure to THA, as recorded in the operative notes and medical records. The primary outcome measured was medical research assessing HRQoL. Secondary outcomes included functionality, complications, pain, and the survival rate of THA. Additional variables considered as potential confounders included age, sex, body mass index, laterality, and comorbidities such as OA, rheumatoid arthritis, systemic lupus erythematosus, juvenile rheumatoid arthritis, ankylosing spondylitis, antiphospholipid syndrome, Sjögren's syndrome, and Still's disease. For the functional assessment, we utilized the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain levels were measured using a Numeric Rating Scale (NRS). The survival rate of THA was evaluated through the Kaplan-Meier method, and HRQoL was assessed using the SF-36 questionnaire. We compared preoperative and postoperative results for the HHS, WOMAC, NRS, and all eight dimensions of the SF-36 within the same group. Continuous variables were described using the mean ± standard deviation (SD) and compared between groups using a student’s t-test. If Levene's test indicated a significant difference in variances, Welch's correction was applied. The magnitude of the difference was denoted as Δ, where a value of 0.2 indicates a small effect size, 0.5 represents a moderate effect size, and a value of 0.8 or higher indicates a large effect size. Binary variables, such as complications, were analyzed as proportions, and results were verified using the chi-square and Fisher's exact tests. Revision-free survival was estimated using the Kaplan-Meier method and compared using the log-rank test, with percentages reported for 10, 20, and 30 years of follow-up. All analyses were conducted using SPSS. The percentage of missing values for each variable was assessed, and all were found to be less than 5%. Little's test (p = 0.27) supported the assumption that the missing data were completely at random (MCAR). A complete case analysis was conducted for baseline and confounding variables, including age, gender and BMI. For outcome scales (HHS, WOMAC, NRS, and SF-36), group-stratified mean imputation was applied when one or fewer items were missing from a domain. Cases with more than one missing item were excluded from that specific analysis. Additionally, a sensitivity analysis was performed by repeating the Cox models and t-tests without imputation, and the estimates varied by less than 5%. Between 1990 and 2020, a total of 50 primary arthroplasties were performed for OA that met the inclusion criteria. To maintain a balanced design, we randomly selected 50 procedures for RP from a pool of 347 eligible cases, achieving a 1:1 ratio (n = 100). With 50 subjects in each group and a SD of 15 points for the total WOMAC score, this sample provides 80% power (α = 0.05, two-tailed) to detect a difference of at least 8.4 points between the two groups. This threshold exceeds the clinically important difference of approximately 7 points that has been reported for THA. Thus, matching the number of patients with RP to the maximum number of available OA cases ensures comparability and adequate analytical power. All clinical and demographic data were extracted from institutional electronic files and entered into a structured format. The following measurement instruments were utilized: 1. HHS: The validated Spanish version demonstrated a Cronbach's alpha of 0.87 and a test-retest intraclass correlation coefficient (ICC) of 0.92, with a minimal clinically important difference (MCID) of 4 points. A trained resident administered the HHS in person under identical conditions for both groups. 2. WOMAC (3.1): This version, using a Likert scale from 0 to 4, has been validated for the Mexican population, showing a Cronbach's alpha of 0.91 and an MCID of approximately 7 points. 3, NRS: ranging from 0 to 10, demonstrates reliability for chronic pain with an ICC of 0.90 or higher. 4, SF-36: The Spanish version of the SF-36 shows a Cronbach's alpha greater than 0.80 across all eight domains, with results reported for physical and mental health components. This structured approach ensures accurate measurement and consistency across evaluations. To reduce selection bias, we implemented bias control for patient selection through simple random sampling at a 1:1 ratio, following the recommendations of the STROBE guidelines. The information collected was entered twice to improve error detection compared to visual methods. We utilized validated Spanish versions of the HHS (α = 0.87; ICC = 0.92), WOMAC (α = 0.91), and NRS 0–10 (ICC ≈ 0.96). To address temporal bias or confounding, we included the date of surgery as a covariate in all multivariable models. Furthermore, we conducted Kaplan-Meier survival analysis, censoring at the last visit or event reported. A follow-up and sensitivity analysis were conducted, with the date of surgery specified as time zero. For events classified as "revision surgery," survival curves were estimated using the Kaplan-Meier method. Censoring was applied under the following conditions: ( 1 ) the last documented visit, ( 2 ) death from a cause unrelated to the prosthesis, or ( 3 ) the cutoff date of June 30, 2024, whichever occurred first. Six percent of patients had missing data, including three from the osteoarthritis group and three from the revision procedure group. The sensitivity analysis employed three approaches: it analyzed complete cases without imputation for all functional outcomes, excluded surgeries performed between 1990 and 1995 (which used first-generation implants) to assess any temporal influence, and utilized a Fine-Gray model to account for death as a competing event regarding the outcome of "revision surgery." The estimates from these analyses were then compared to those of the main model, with any differences of less than 5% considered negligible. Results From 1990 to 2020, a study was conducted at a tertiary or specialty medical reference hospital in Mexico. Out of 458 eligible patients, 30 died for reasons unrelated to THA, 28 had their surgeries performed at other facilities, and eight declined to participate. Among the 400 patients who underwent THA, 80% were diagnosed with RP, 11% had OA, and less than 9% reported traumatic conditions; therefore, we employed a simple random sampling, stratified by diagnosis, selecting 50 procedures for primary OA and 50 for RP, ensuring a 1:1 ratio. Individual matching was not utilized to maintain true clinical heterogeneity. All surgeries were performed by three hip reconstruction surgeons who served throughout the entire study period to minimize variability in operative techniques. The date of surgery was included as a covariate to account for potential changes in surgical techniques and perioperative management over time. Our hospital serves as a referral center for patients with specialized conditions that need advanced or complex treatment. With support from our Rheumatology Department, patients received confirmatory tests to identify their specific conditions, along with clinical evaluations and detailed analytical assessments. The methodology used for all participants in this study is illustrated in Fig. 1 . Methodology used for all participants in our study The initial demographic analysis indicated that the OA group had a mean age of 58 ± 13 years, with 66% of the patients being female and 34% male. In comparison, the RP group had a mean age of 35 ± 12 years, with 64% female and 36% male patients. There were no significant differences in Body Mass Index (BMI) between the two groups, with values of 29 ± 3 kg/m² for the OA group and 28 ± 5 kg/m² for the RP group (p = 0.18). This suggests that the distributions of sex and body composition were comparable between the two groups. The intervention was conducted more often on the right hip in the OA group (70%) compared to the RP group (50%). This difference was statistically significant (p = 0.042), suggesting a slight preference for the right side in the OA cohort. The comorbidities reported in the RP group were rheumatoid arthritis (38%), systemic lupus erythematosus (26%), juvenile rheumatoid arthritis (24%), and ankylosing spondylitis (10%). Less common comorbidities included antiphospholipid syndrome (6%), Sjögren's syndrome (4%), and Still's disease (4%). Most patients in the RP group received steroid treatment, and avascular necrosis of the femoral head was reported in 46% of these patients. Complication rates were low in both groups studied. The most common adverse event was aseptic loosening, which occurred in 28% of the OA group and 20% of the RP group. The second most frequent adverse event was polyethylene wear, with rates of 10% in the OA group and 8% in the RP group. The third most common adverse event was the need for revision surgery, which occurred at a rate of 6% in both groups. When comparing the two groups using student's t-test for binary variables, none of these differences were statistically significant. Additionally, infectious and neurological complications were rare, occurring in 4% or fewer cases. The complications between the groups are summarized in Table 1 . There were a few missing values (less than 5% for all variables), and they did not show a differential pattern between groups (p = 0.27). The results after imputation and analysis of complete cases were similar. A few missing values (less than 5% for all variables), and they did not show a differential pattern between groups (p = 0.27). The results after imputation and analysis of complete cases were comparable. Table 1 Complications related to THA between study groups Complications OA group (%) RP group (%) P-value Septic loosening 6 0 0.083 Aseptic loosening 28 20 0.354 Periprosthetic fracture 2 4 0.562 Periprosthetic dislocation 4 2 0.562 Revision surgery 6 6 1.000 Polyethylene wear 10 8 0.730 Periprosthetic infection 4 2 0.562 Chronic pain 0 2 0.322 Sciatic nerve injury 0 2 0.322 Frequency of complications reported between groups, and the P-value was estimated using the student’s t-test for binary variables Table 2 presents a summary of the preoperative and postoperative changes in HHS, WOMAC, and NRS for the two study groups. For each variable, we provide the mean and SD before and after surgery, the mean difference between the two phases (Δ = postoperative - preoperative) along with its 95% CI, the p-value from the paired t-test, and the Cohen's d effect size. In scales as HHS a higher value indicates a better status, positive Δ and d values signify an improvement. Conversely, in scales where a lower value reflects a better outcome (such as WOMAC and NRS), negative Δ and d values indicate improvement. The magnitude of the treatment effect was estimated using Cohen's d. A magnitude of 0.2–0.5 indicates a small effect, 0.5–0.8 indicates a moderate effect, 0.8–1.2 indicates a large effect, and greater than 1.2 indicates a very large effect Table 2 Functional and pain scores between the two study groups Funtional and pain outcomes Preoperative mean ± SD Postoperative mean ± SD Δ IC 95% Δ P-value Cohen d HHS (OA) 34.6 ± 5.0 79.8 ± 10.2 45.2 42.4–48.0 < 0.001 4.56 HHS (RP) 33.8 ± 6.8 86.6 ± 11.8 52.9 49.6–56.2 < 0.001 4.56 WOMAC (OA) 78.1 ± 10.9 30.3 ± 10.5 -47.7 -52.8–-42.6 < 0.001 -2.65 WOMAC (RP) 76.0 ± 7.6 24.5 ± 9.0 -51.6 -54.2–-48.9 < 0.001 -5.52 NRS (OA) 8.4 ± 0.8 2.6 ± 1.5 -5.8 -6.3–-5.3 < 0.001 -3.44 NRS (RP) 8.6 ± 1.2 0.9 ± 1.5 -7.6 -8.2–-7.1 < 0.001 -4.18 The magnitude of the treatment effect (Cohen's d) were greater than or equal to 2 for the WOMAC and NRS and greater than or equal to 4 for the HHS. These values indicate substantial improvements. The HHS scale increased by approximately 48 points in the OA group and 54 points in the RP group (p < 0.001). These values are six to seven times the usual clinically important difference of seven points or more, and their Cohen's effect sizes are classified as "huge," indicating that virtually all patients moved from severe disability to nearly normal function. WOMAC scores decreased by approximately 45–51 points in both groups, with a Cohen's d effect size of at least 2.0. NRS pain scores decreased in both groups, with the decrease being much greater than the MCID of 1.5. Negative WOMAC and NRS values reflect improvement since lower numbers on these scales indicate less pain and disability. Comparing the groups shows better results in the WOMAC, HHS, and NRS scales. This means that these patients obtain an additional functional and analgesic advantage in the long term. To assess health-related quality of life, the health assessment consists of eight dimensions and each domain is scored from 0 to 100, with higher scores indicating better health. Significant increases were observed in both groups from the preoperative phase to the 20-year measurements. According to Cohen's conventional categories, the effect sizes indicated notable and clinically relevant gains, ranging from 1.11 in emotional well-being for the OA group to 10.75 in physical functioning for the RP group. The domains that showed the most remarkable absolute change were physical functioning and role-physical, which demonstrated the greatest improvement. The RP group achieved slightly higher postoperative values for physical functioning (97.0 ± 9.0) compared to the OA group (92.7 ± 12.6). In the role-physical domain, both groups experienced substantial gains, although the increase was slightly greater in the OA group. The energy and general health dimensions showed more modest differences; however, the changes remained statistically and clinically significant. At 20 years, the median score for most domains was above 80, indicating the maintenance of excellent function and quality of life. Table 3 report the SF-36 evaluation between the two study groups in the preoperative vs postoperative outcomes. Table 3 SF-36 outcomes between both study groups Outcomes Preoperative mean ± SD Postoperative mean ± SD Δ P-value Cohen´s d Physical functioning (OA) 7.2 ± 14.8 92.7 ± 12.6 85.5 < 0.001 4.11 Physical functioning (PR) 0.0 ± 0.0 97.0 ± 9.0 97.0 < 0.001 10.75 Role physical (OA) 1.0 ± 4.9 95.5 ± 20.0 94.5 < 0.001 4.64 Role physical (PR) 11.7 ± 12.5 100.0 ± 0.0 88.3 < 0.001 7.07 Role emotional (OA) 4.7 ± 15.1 95.3 ± 20.2 90.7 < 0.001 3.73 Role emotional (PR) 16.3 ± 16.7 100.0 ± 0.0 83.7 < 0.001 5.02 Energy (OA) 42.3 ± 18.7 65.0 ± 11.4 22.7 < 0.001 1.22 Energy (PR) 56.1 ± 9.3 71.0 ± 8.3 14.9 < 0.001 1.36 Emotional well-being (OA) 55.3 ± 20.7 82.4 ± 17.4 27.1 < 0.001 1.11 Emotional well-being (PR) 64.1 ± 19.2 86.1 ± 10.9 22.0 < 0.001 0.83 Social functioning (OA) 26.8 ± 22.0 75.8 ± 20.3 49.1 < 0.001 1.94 Social functioning (PR) 17.5 ± 13.5 96.7 ± 6.1 79.2 < 0.001 5.51 Pain (OA) 27.4 ± 24.3 81.6 ± 14.7 54.2 < 0.001 2.09 Pain (PR) 16.3 ± 14.9 94.3 ± 10.8 78.1 < 0.001 4.21 General health (OA) 39.5 ± 9.3 65.1 ± 19.0 25.6 < 0.001 1.44 General health (PR) 19.8 ± 12.3 50.2 ± 9.3 30.4 < 0.001 1.86 Positive Δ values indicate an increase, while negative Δ values suggest a decrease (improvement) on scales where a higher score reflects a worse status, such as WOMAC and VAS. The P value was calculated using paired t-tests, and Cohen's d was used to interpret the effect size, with 0.2 considered small, 0.5 moderate, and 0.8 large. A stepwise approach was employed to evaluate the impact of diagnosis on prosthetic function and survival. Initially, crude means of functional scores and the raw risk of revision were compared. Subsequently, models were adjusted for age (≤ 65/≥65 years), sex, BMI (≤ 30/≥30 kg/m²), and year of surgery. Finally, hazard ratios were converted into absolute odds ratios using Kaplan-Meier curves. In the unadjusted analysis, patients with rheumatologic conditions scored 9.3 points higher on the physical component of the SF-36 compared to those with osteoarthritis (95% CI: 4.1–14.5; p = 0.001). They also demonstrated advantages of 7.2 points on the WOMAC (95% CI: 2.5–11.8) and 6.5 points on the HHS (95% CI: 1.9–11.1). After multivariate adjustments, clinically relevant differences persisted: +8.9 points on the SF-36 (95% CI: 3.2–14.6), + 6.8 points on the WOMAC (95% CI: 2.1–11.5), and + 6.1 points on the HHS (95% CI: 1.5–10.7). The hazard ratio for any revision was found to be 1.28 (CI: 0.73–2.24) in the crude model and 1.23 (CI: 0.70–2.16) following adjustments. This supported the proportional hazards assumption (Schoenfeld residuals: p > 0.10). The cumulative probability of revision was 12% at 10 years and 18% at 20 years for osteoarthritis, compared to 9% and 14%, respectively, for rheumatologic conditions. These absolute differences were 3% and − 4%, respectively, affirming that there is no detrimental effect on implant survival for patients with inflammatory diseases despite their superior functional performance. A radar plot showing the postoperative results of the OA group is in Fig. 2 , and the postoperative results of the RP group are in Fig. 3 , where preoperative results were reported in blue and the postoperative results in orange. The radar plot of SF-36 scale results reports a better perception of the general health of this group, and we can observe that baseline pain between groups is similar. Radar plot of SF-36 scale results reports role limitations in emotional problems, energy, social functioning, pain, and general health in the postoperative stage. After 30 years, both groups reported excellent results. However, patients with RP have a slight advantage in terms of function, energy, social interaction, and residual pain. Patients in OA group tend to have a more positive perception of their overall health. The physical functioning dimension of the SF-36 survey reported a marginal advantage for the RP group. Additionally, the energy and social functioning dimensions are significantly higher for the RP group. Notably, the general health dimension is 15 points lower in the RP group, indicating a less favorable self-perception of overall health despite better functioning and lower pain levels. The remaining dimensions: role physical, role-emotional, emotional well-being, and pain did not show clinically relevant differences. Table 4 presents the differences between pathologies (OA versus PR) following surgery. Table 4 Evaluation of SF-36 differences between pathologies after surgery. Outcomes Mean OA group ± SD Mean RP group ± SD Mean Δ IC 95% P-value Hedge's g Levene's test Physical functioning 92.7 ± 12.6 97.0 ± 9.0 4.3 -0.0–8.7 0.050 0.39 0.050 Role physical 95.5 ± 20.0 100.0 ± 0.0 4.5 -1.1–10.1 0.114 0.32 0.114 Role emotional 95.3 ± 20.2 100.0 ± 0.0 4.7 -1.0–10.3 0.105 0.32 0.105 Energy 65.0 ± 11.4 71.0 ± 8.3 6.0 2.1–10.0 0.003 0.60 0.000 Emotional well-being 82.4 ± 17.4 86.1 ± 10.9 3.7 -2.1–9.5 0.204 0.25 0.011 Social functioning 75.8 ± 20.3 96.7 ± 6.1 20.8 14.9–26.8 0.000 1.38 0.000 Pain 81.6 ± 14.7 94.3 ± 10.8 12.7 7.6–17.9 0.000 0.98 0.094 General health 65.1 ± 19.0 50.2 ± 9.3 -14.9 -20.8–-9.0 0.000 -0.99 0.000 The values for each domain were compared using Student's t-test for independent samples. The results include the mean Δ (difference between pathologies), its 95% confidence interval, the P-value, and the effect size (Hedges g). An effect size of g ≥ 0.5 was considered clinically significant. In the 20-year intergroup comparison, patients in the RP group reported higher scores in six out of the eight SF-36 domains. These differences were statistically and clinically significant in the areas of energy (> 6.0 points; g = 0.60), social functioning (> 20.8 points; g = 1.38), and pain (> 12.7 points; g = 0.98). The difference in physical functioning was borderline significant, with a score of 4.3 points (p = 0.051). No differences were observed in the physical or emotional role scales between the groups. The general health domain favored the osteoarthritis group. Overall, these results suggest that patients with RP maintain or even exceed the quality of life seen in patients with OA, especially regarding pain and social participation, though they reported lower global health perception. The cumulative probability of remaining free from revision was high and comparable between the two groups: for the OA group, it was 93.8% at 10 years and 90.6% at 30 years; for the PR group, it was 97.8% at 10 years and 93.2% at 30 years. The log-rank test indicated no significant differences between the two curves (p = 0.78). Additionally, the adjusted Cox model showed a hazard ratio (HR) of 1.08 (95% CI, 0.24–4.86; p = 0.92). Survival of patients who underwent THA are reported in Fig. 4 . Kaplan-Meier curve illustrating the cumulative probability of remaining revision-free after THA. At 10 years, the survival rate was 98%; at 20 years, it was 93%, and the rate remained unaffected by new events until the 30-year follow-up. Discussion THA is the treatment of choice for patients with severe joint damage. It is considered the surgery of the century because it restores mobility and reduces pain. The most common indication is OA, followed by RP with inflammation and severe joint involvement ( 1 , 2 , 3 ). In patients with RP, the medical treatment is pharmacological, with the use of non-steroidal anti-inflammatory drugs, glucocorticoids, immunosuppressants, and disease-modifying antirheumatic drugs; however, a low percentage of patients report after glucocorticoid treatments’ avascular necrosis of the femoral head ( 4 , 5 , 6 , 7 , 8 ). As we can observe, both study groups presented similar complications, such as aseptic loosening and polyethylene wear. On the other hand, RP patients presented a higher frequency of revision surgery, in addition to being younger patients and exposed to greater mobility due to their greater wear, which is related to young patients after THA ( 20 , 21 , 22 ). Therefore, throughout the history of THA, surgical protocols have been performed to restore mobility and quality of life towards 2030 and to the future and avoid complications related with THA ( 2 , 25 , 26 , 27 ). The bibliography widely reports functionality in patients diagnosed with OA. Conversely, patients with limitations, such as patients with RP, become essential in recovering mobility and quality of life ( 26 , 27 , 28 , 29 , 30 ). In our study, we reported improvement in the HHS and WOMAC index in both study groups; we reported better postoperative results in the RP groups, consistent with the literature regarding mobility and functionality after THA, even in patients with chronic inflammatory pathologies ( 5 , 12 , 13 , 23 , 24 ). THA demonstrated significant improvements in pain and function for both groups, surpassing the MCID by a considerable margin. Nevertheless, patients with RP enjoyed additional long-term functional and pain relief benefits. The SF-36 health facilitates cost-effectiveness analysis. Indeed, its use has been reported in young patients, and its daily use is in the postoperative course ( 14 , 15 , 16 , 17 , 18 , 19 ). In both groups, we observed a statistically and clinically significant increase in all SF-36 domains, with a particular emphasis on mental health; after surgery, the mental health and vitality scores were above 80% of the maximum possible, indicating an overall positive emotional state following THA. Notable improvements were seen in the RP group across several domains, including limitations due to emotional problems, energy/vitality, social function, bodily pain, and general health, with effect sizes (d) of 1.0 or greater. This suggests that there is an additional psychological benefit that accompanies functional recovery. Since RP patients typically face greater sarcopenia, mobility restrictions, and severe pain, the reduction in pain and the improvement in function following THA may help explain the extent of their emotional enhancement. The literature indicates that preoperative psychosocial factors such as anxiety, depression, pain catastrophizing, and low self-esteem are linked to poorer postsurgical satisfaction. However, in our cohort, it appears that surgical intervention helps mitigate these negative predictors, as demonstrated by the significant improvements in mental health domains. In 2020, Pallante et al. and Melissa et al. (2017) reported comparable survival rates after THA in patients younger than 12 years ( 8 , 9 ). A meta-analysis by Evans et al. in 2019 found that the 12-year survival rate is 98% for men and 93% for women under 50 years of age. These results align closely with those of Chang et al. in 2020, which showed a survival rate of 89.4% at 15 years, 70.2% at 20 years, and 57.9% at 25 years among patients who underwent THA ( 10 ). According to the Mayo Clinic, studies of patients younger than 20 years with a clinical follow-up of 20 years revealed a survival rate with a revision of 97.2% at 10 years, based on data from 138 patients treated between 1998 and 2016 ( 11 ). However, our findings indicate that the survival rates observed in this study are higher than those reported in previous research. Significant improvements in health-related quality of life were observed across all domains. The RP group experienced additional benefits in emotional well-being, vitality, social functioning, and bodily pain, indicating psychological and social advantages alongside physical relief. These findings demonstrate that THA has a clinically significant impact on pain, function, and overall health, regardless of the underlying cause of the condition. The limitations of the study arise from its execution in a tertiary-level hospital, which may have introduced bias by enrolling only patients with complex pathologies. This selection bias is rooted in the inclusion criteria, specifically designed to accommodate individuals with complex conditions requiring specialized treatments. Consequently, it is crucial to recognize that the results may not be easily generalizable to less specialized care settings with larger, more diverse patient populations. Despite the availability of advanced resources at this hospital, the study did not make comparisons with less complex cohorts or institutions at different levels of care. Furthermore, three reconstruction surgeons at this facility have followed relatively consistent protocols and employed similar technologies for the past three decades. As such, the outcomes documented here may be more applicable to hospitals with comparable expertise and resources, particularly specialized units equipped with systematic follow-up and access to formal rehabilitation. This is particularly relevant for Latin America and other regions with similar demographic profiles, especially adults aged 45 to 80 years, with a predominance of females and moderate levels of comorbidity. Additionally, the use of cross-culturally validated outcome instruments (such as the SF-36, WOMAC, and HHS) enhances the international comparability of functional outcomes. Several limitations should be considered: First, the implants and perioperative antibiotics used during the study period may have changed and differ from those available today in lower-volume centers. Second, the 1:1 purposive sampling (50 patients with OA and 50 with RP ensures analytical balance but does not accurately represent the actual proportions of these conditions in clinical practice. Third, Mexico's public health system provides coverage for hospital stays and rehabilitation that might not be available in private insurance systems or regions with limited resources. Therefore, caution should be exercised when applying these results to low-volume hospitals, populations with different ethnic backgrounds, or shortened rehabilitation programs. Whenever possible, these findings should be validated with contemporary multicenter studies. In summary, THA offers durability of 30 years or more, along with notable improvements in functional and pain relief for patients with OA and those in the RP group. Despite starting from a position of greater frailty, the RP group enjoys extra benefits in terms of both physical and emotional well-being. A thorough evaluation using the HHS, WOMAC, NRS, and the SF-36 confirms that the success of the intervention extends beyond mere joint mobility and positively influences overall health and long-term quality of life. To achieve an excellent postoperative outcome, it is essential to optimize both the physical and emotional aspects before and after surgery. The ultimate goal is to enhance patients' quality of life. Conclusions This study examined patients with RP and OA and found that THA can demonstrate remarkable durability, providing sustained benefits for up to 30 years. The revision-free survival rate exceeded 90% in both patient groups, indicating that a rheumatic etiology does not impact the longevity of prosthetic implants. Functionally, the HHS improved by an average of 48 points for OA patients and 54 points for RA patients. Additionally, the WOMAC score decreased by 45 to 51 points. The pain NRS score fell significantly below the MCID, exhibiting effect sizes (d ≥ 2). This indicates a shift from severe disability to nearly normal function. The SF-36 scale also showed significant improvements across all domains, with RA patients experiencing extra benefits in vitality, social functioning, and bodily pain, highlighting the importance of the emotional aspect of recovery. These findings emphasize that to maximize functional gains, pain relief, and patient satisfaction, THA should be complemented by physical and psychosocial optimization strategies both before and after surgery. By incorporating a multidimensional assessment and extended follow-up in a Latin American population, our study provides strong evidence that hip arthroplasty is a durable and transformative intervention, particularly when approached in a multidisciplinary mode. Abbreviations BMI: Body Mass Index CI: Confidence Interval HHS: Harris Hip Score HR: Hazard ratio HRQoL: health-related quality of life ICC: intraclass correlation coefficient MCAR: missing data were completely at random MCID: minimum clinically important difference MOS: Medical Outcomes Study OA: osteoarthritis RP: Rheumatic Pathologies SD: Standard deviation SF-36: Short Form 36 Health Survey. THA: Total Hip Arthroplasty WOMAC: Western Ontario and McMaster Universities Osteoarthritis index Δ: The magnitude of the difference Declarations Ethics approval and consent to participate Approval for this study was obtained from the Institutional Review Board at the Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubiran. (registration CONBIOETICA- A-09-CEI-011-20160627, official letter OFICIO-NO. MCONTROL-1467/2023). Our research was conducted in accordance with the Declaration of Helsinki and the Mexican national guidelines for health research in humans (NOM-012-SSA3-2012). All participants provided written informed consent before enrolling in the study. Consent for publication Not applicable. The manuscript does not contain any individual person’s data. Availability of data and materials The datasets generated during and analyzed during the current study are available in the Zenodo repository, available from: https://zenodo.org. DOI 10.5281/zenodo.15664128. Competing interests The authors declare that they have no competing interests Funding The authors declare that they have no sources of funding for the research reported in this study. Authors' contributions Virginia Elizabeth Macias Mosquera. Contribution: Data Curation Luis David Marcial Barba. Contribution: Supervision Diego Laverde Osorio. Contribution: Data Curation Efrain Diaz Borjon. Contribution: Conceptualization Juan Montejo Vargas. Contribution: Writing - Review & Editing Georges Jirjis Makdissy Salomon. Contribution: Writing - Original Draft Christian Hazel Hernandez Romero. Contribution: Methodology Acknowledgements We would like to thank the Department of Rheumatology at our medical unit, with whom we collaborated to develop reliable research. References Markatos K, Savvidou OD, Foteinou A, Kosmadaki S, Trikoupis I, Goumenos SD, et al. Hallmarks in the history and development of total hip arthroplasty. Surg Innov. 2020;27(6):691–4. 10.1177/1553350620947209 . Goodman SM, Springer BD, Chen AF, Davis M, Fernandez DR, Figgie M, et al. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. J Arthroplasty. 2022;37(9):1676–83. 10.1016/j.arth.2022.05.043 . Bahl JS, Nelson MJ, Taylor M, Solomon LB, Arnold JB, Thewlis D. Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. 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J Orthop Sci. 2016;21(4):500–6. 10.1016/j.jos.2016.03.009 . Xiao M, Wang Q, Liu T, Ma C, Yang L, Liu F, et al. Effect of Otago exercise programme on limb function recovery in elderly patients with hip arthroplasty for femoral neck fracture. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022;47(9):1244–52. 10.11817/j.issn.1672-7347.2022.220307 . Widmer P, Oesch P, Bachmann S. Effect of prehabilitation in form of exercise and/or education in patients undergoing total hip arthroplasty on postoperative outcomes: a systematic review. Med (Kaunas). 2022;58(6):742. 10.3390/medicina58060742 . Laucis NC, Hays RD, Bhattacharyya T. Scoring the SF-36 in orthopaedics: a brief guide. J Bone Joint Surg Am. 2015;97(19):1628–34. 10.2106/JBJS.O.00030 . Mei XY, Gong YJ, Safir O, Gross A, Kuzyk P. Long-term outcomes of total hip arthroplasty in patients younger than 55 years: a systematic review of the contemporary literature. Can J Surg. 2019;62(4):249–58. 10.1503/cjs.013118 . Negm AM, Beaupre LA, Goplen CM, Weeks C, Jones CA. A scoping review of total hip arthroplasty survival and reoperation rates in patients 55 years or younger: health services implications for revision surgeries. Arthroplast Today. 2022;16:247–e586. 10.1016/j.artd.2022.05.012 . Zampogna B, Papalia GF, Ferrini A, Torre G, Vorini F, Diaz Balzani LA, et al. Dual-mobility total hip arthroplasty in patients younger than 55 years old: a systematic review. Arch Orthop Trauma Surg. 2023;143(11):6821–8. 10.1007/s00402-023-04882-2 . Guyen O. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res. 2019;105(1S):S95–101. 10.1016/j.otsr.2018.04.034 . Barik S, Jain A, Chanakya PV, Raj V, Goyal T. What has changed in total hip arthroplasty in patients of juvenile idiopathic arthritis since 2000? A systematic review and pooled data analysis. Eur J Orthop Surg Traumatol. 2023;33(7):2737–48. 10.1007/s00590-023-03525-x . Parvizi J, Gehrke T, editors. Segundo Consenso Internacional sobre Infecciones Musculoesqueléticas. Madrid: Imaidea Interactiva; 2018. Schwartz AM, Farley KX, Guild GN, Bradbury TL Jr. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty. 2020;35(6 Suppl):S79–85. 10.1016/j.arth.2020.02.030 . Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry DJ, Parvizi J. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009;467(10):2606–12. 10.1007/s11999-009-0834-6 . Katz JN, Losina E, Collins JE, Wright EA, Solomon DH. The impact of pre-operative opioid use on outcomes after total knee arthroplasty: a prospective cohort study. J Bone Joint Surg Am. 2023;105(17):1492–500. 10.2106/JBJS.23.00123 . Ries MD. Relationship between functional anatomy of the hip and surgical approaches in total hip arthroplasty. Orthopedics. 2019;42(4):e356–63. 10.3928/01477447-20190624-03 . Dimitriou D, Antoniadis A, Flury A, Liebhauser M, Helmy N. Total hip arthroplasty improves the quality-adjusted life years in patients who exceeded the estimated life expectancy. J Arthroplasty. 2018;33(11):3484–9. 10.1016/j.arth.2018.07.005 . Dataset. Hernández-Romero CH, et al. Dataset for: Evaluation of general health status in total hip arthroplasty patients, 30-year cohort study. Zenodo. 2025. 10.5281/zenodo.15664128 . Additional Declarations No competing interests reported. Supplementary Files SupplementarymaterialSTROBEv4.doc Supplementarymaterial1Table1.xlsx Supplementarymaterial2Table2.xlsx Supplementarymaterial3Table3.xlsx Supplementarymaterial4Table4.xlsx Supplementarymaterial5Figure1.tif Supplementarymaterial6Figure2.tif Supplementarymaterial7Figure3.png Supplementarymaterial8Figure4.tif Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6895475","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":474208523,"identity":"64899308-f1a6-4175-b6c4-b5990a27ea8a","order_by":0,"name":"Virginia Elizabeth Macias Mosquera","email":"","orcid":"","institution":"Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán","correspondingAuthor":false,"prefix":"","firstName":"Virginia","middleName":"Elizabeth Macias","lastName":"Mosquera","suffix":""},{"id":474208524,"identity":"6bb13d72-07fb-4555-aec4-37f0f801eeb4","order_by":1,"name":"Luis David Marcial 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Often referred to as the \"surgery of the century,\" it helps restore mobility and alleviate pain. The most common reason for performing THA is osteoarthritis (OA), followed by rheumatic pathologies (RP), which involve inflammation and significant joint involvement (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In patients suffering from RP, medical treatment typically includes pharmacological options such as non-steroidal anti-inflammatory drugs, glucocorticoids, immunosuppressants, and disease-modifying antirheumatic drugs. Continuous physical rehabilitation therapy is also crucial. An important percentage of patients who receive glucocorticoid treatments report developing avascular necrosis of the femoral head (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe functionality of patients diagnosed with OA has been extensively documented in the literature. In contrast, patients with restrictions, such as those with RP, are crucial for restoring mobility and improving quality of life (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The Short Form 36 Health Survey (SF-36) is a tool used to evaluate quality of life. Developed in 1980 as part of the Medical Outcomes Study (MOS), this survey is employed in medical research to assess health-related quality of life (HRQoL) in an \"objective\" and multidimensional manner. The SF-36 evaluates several dimensions, including physical functioning, limitations due to physical health, limitations due to emotional problems, energy and fatigue, emotional well-being, social functioning, pain, and general health, according to the research of Liu et al. in 2019 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, its application in THA for assessing patient satisfaction has been limited in arthroplasty procedures (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Concerning THA-related survival, studies involving patients with RP and younger individuals have reported an average survival rate of approximately 10 to 15 years, which tends to decrease over time (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe will conduct a 30-year longitudinal evaluation of health-related quality of life following primary THA. Our goal is to quantify long-term changes in function, pain, and overall well-being and to determine whether patients with RP experience greater improvements than those with primary OA across physical, mental, and social domains. We hypothesize that when the systemic disease is adequately controlled, RP recipients will achieve larger and more sustained gains than their OA counterparts. Few studies have tracked these dimensions related to THA.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study is a retrospective comparative cohort analysis conducted at the Hip and Knee Joint Reconstruction Service of a specialized referral hospital in Mexico City. The cohort includes all total THA performed from January 1, 1990, to December 31, 2020. Our primary data sources consisted of institutional electronic medical records and a departmental arthroplasty database, specifically focusing on a Latin American population. We utilized the comprehensive database from the Hip and Knee Joint Reconstruction Service, which contains detailed information about patients who have undergone THA. A total of 458 patients from this database were evaluated, with a follow-up period of 30 years. Our population showed a high prevalence of patients with RP, and we employed a simple random sampling, stratified by diagnosis, selecting 50 procedures for primary OA and 50 for RP, ensuring a 1:1 ratio. Individual matching was not utilized to maintain true clinical heterogeneity. All surgeries were performed by three hip reconstruction surgeons who served throughout the entire study period to minimize variability in operative techniques. We employed simple random sampling and conducted a loss analysis to minimize selection bias. To reduce information bias, we performed double data entry and conducted a reconciliation process. Additionally, we adjusted the log-rank and Cox models for factors such as age, gender, BMI, and comorbidities to account for potential confounding variables.\u003c/p\u003e \u003cp\u003eThe eligibility criteria for participant selection were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) participants must be at least 18 years old, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) must have a Kellgren\u0026ndash;Lawrence grade IV coxarthrosis, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) must have undergone primary THA at our institution during the study period. Exclusion criteria included death during follow-up, having the surgery performed at another institution, or refusal to participate in the study. Out of 458 eligible patients, 30 died for reasons unrelated to THA, 28 had their surgery performed elsewhere, and eight declined to participate. All data were collected by two independent reviewers using a standardized collection form, and any discrepancies were resolved by consensus. The information gathered for analysis included exposure to THA, as recorded in the operative notes and medical records.\u003c/p\u003e \u003cp\u003eThe primary outcome measured was medical research assessing HRQoL. Secondary outcomes included functionality, complications, pain, and the survival rate of THA. Additional variables considered as potential confounders included age, sex, body mass index, laterality, and comorbidities such as OA, rheumatoid arthritis, systemic lupus erythematosus, juvenile rheumatoid arthritis, ankylosing spondylitis, antiphospholipid syndrome, Sj\u0026ouml;gren's syndrome, and Still's disease.\u003c/p\u003e \u003cp\u003eFor the functional assessment, we utilized the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain levels were measured using a Numeric Rating Scale (NRS). The survival rate of THA was evaluated through the Kaplan-Meier method, and HRQoL was assessed using the SF-36 questionnaire. We compared preoperative and postoperative results for the HHS, WOMAC, NRS, and all eight dimensions of the SF-36 within the same group. Continuous variables were described using the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and compared between groups using a student\u0026rsquo;s t-test. If Levene's test indicated a significant difference in variances, Welch's correction was applied. The magnitude of the difference was denoted as Δ, where a value of 0.2 indicates a small effect size, 0.5 represents a moderate effect size, and a value of 0.8 or higher indicates a large effect size. Binary variables, such as complications, were analyzed as proportions, and results were verified using the chi-square and Fisher's exact tests. Revision-free survival was estimated using the Kaplan-Meier method and compared using the log-rank test, with percentages reported for 10, 20, and 30 years of follow-up. All analyses were conducted using SPSS. The percentage of missing values for each variable was assessed, and all were found to be less than 5%. Little's test (p\u0026thinsp;=\u0026thinsp;0.27) supported the assumption that the missing data were completely at random (MCAR). A complete case analysis was conducted for baseline and confounding variables, including age, gender and BMI. For outcome scales (HHS, WOMAC, NRS, and SF-36), group-stratified mean imputation was applied when one or fewer items were missing from a domain. Cases with more than one missing item were excluded from that specific analysis. Additionally, a sensitivity analysis was performed by repeating the Cox models and t-tests without imputation, and the estimates varied by less than 5%.\u003c/p\u003e \u003cp\u003eBetween 1990 and 2020, a total of 50 primary arthroplasties were performed for OA that met the inclusion criteria. To maintain a balanced design, we randomly selected 50 procedures for RP from a pool of 347 eligible cases, achieving a 1:1 ratio (n\u0026thinsp;=\u0026thinsp;100). With 50 subjects in each group and a SD of 15 points for the total WOMAC score, this sample provides 80% power (α\u0026thinsp;=\u0026thinsp;0.05, two-tailed) to detect a difference of at least 8.4 points between the two groups. This threshold exceeds the clinically important difference of approximately 7 points that has been reported for THA. Thus, matching the number of patients with RP to the maximum number of available OA cases ensures comparability and adequate analytical power.\u003c/p\u003e \u003cp\u003eAll clinical and demographic data were extracted from institutional electronic files and entered into a structured format. The following measurement instruments were utilized: 1. HHS: The validated Spanish version demonstrated a Cronbach's alpha of 0.87 and a test-retest intraclass correlation coefficient (ICC) of 0.92, with a minimal clinically important difference (MCID) of 4 points. A trained resident administered the HHS in person under identical conditions for both groups. 2. WOMAC (3.1): This version, using a Likert scale from 0 to 4, has been validated for the Mexican population, showing a Cronbach's alpha of 0.91 and an MCID of approximately 7 points. 3, NRS: ranging from 0 to 10, demonstrates reliability for chronic pain with an ICC of 0.90 or higher. 4, SF-36: The Spanish version of the SF-36 shows a Cronbach's alpha greater than 0.80 across all eight domains, with results reported for physical and mental health components. This structured approach ensures accurate measurement and consistency across evaluations.\u003c/p\u003e \u003cp\u003e To reduce selection bias, we implemented bias control for patient selection through simple random sampling at a 1:1 ratio, following the recommendations of the STROBE guidelines. The information collected was entered twice to improve error detection compared to visual methods. We utilized validated Spanish versions of the HHS (α\u0026thinsp;=\u0026thinsp;0.87; ICC\u0026thinsp;=\u0026thinsp;0.92), WOMAC (α\u0026thinsp;=\u0026thinsp;0.91), and NRS 0\u0026ndash;10 (ICC\u0026thinsp;\u0026asymp;\u0026thinsp;0.96). To address temporal bias or confounding, we included the date of surgery as a covariate in all multivariable models. Furthermore, we conducted Kaplan-Meier survival analysis, censoring at the last visit or event reported.\u003c/p\u003e \u003cp\u003eA follow-up and sensitivity analysis were conducted, with the date of surgery specified as time zero. For events classified as \"revision surgery,\" survival curves were estimated using the Kaplan-Meier method. Censoring was applied under the following conditions: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the last documented visit, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) death from a cause unrelated to the prosthesis, or (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) the cutoff date of June 30, 2024, whichever occurred first. Six percent of patients had missing data, including three from the osteoarthritis group and three from the revision procedure group. The sensitivity analysis employed three approaches: it analyzed complete cases without imputation for all functional outcomes, excluded surgeries performed between 1990 and 1995 (which used first-generation implants) to assess any temporal influence, and utilized a Fine-Gray model to account for death as a competing event regarding the outcome of \"revision surgery.\" The estimates from these analyses were then compared to those of the main model, with any differences of less than 5% considered negligible.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFrom 1990 to 2020, a study was conducted at a tertiary or specialty medical reference hospital in Mexico. Out of 458 eligible patients, 30 died for reasons unrelated to THA, 28 had their surgeries performed at other facilities, and eight declined to participate. Among the 400 patients who underwent THA, 80% were diagnosed with RP, 11% had OA, and less than 9% reported traumatic conditions; therefore, we employed a simple random sampling, stratified by diagnosis, selecting 50 procedures for primary OA and 50 for RP, ensuring a 1:1 ratio. Individual matching was not utilized to maintain true clinical heterogeneity. All surgeries were performed by three hip reconstruction surgeons who served throughout the entire study period to minimize variability in operative techniques. The date of surgery was included as a covariate to account for potential changes in surgical techniques and perioperative management over time.\u003c/p\u003e \u003cp\u003eOur hospital serves as a referral center for patients with specialized conditions that need advanced or complex treatment. With support from our Rheumatology Department, patients received confirmatory tests to identify their specific conditions, along with clinical evaluations and detailed analytical assessments. The methodology used for all participants in this study is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMethodology used for all participants in our study\u003c/p\u003e \u003cp\u003eThe initial demographic analysis indicated that the OA group had a mean age of 58\u0026thinsp;\u0026plusmn;\u0026thinsp;13 years, with 66% of the patients being female and 34% male. In comparison, the RP group had a mean age of 35\u0026thinsp;\u0026plusmn;\u0026thinsp;12 years, with 64% female and 36% male patients. There were no significant differences in Body Mass Index (BMI) between the two groups, with values of 29\u0026thinsp;\u0026plusmn;\u0026thinsp;3 kg/m\u0026sup2; for the OA group and 28\u0026thinsp;\u0026plusmn;\u0026thinsp;5 kg/m\u0026sup2; for the RP group (p\u0026thinsp;=\u0026thinsp;0.18). This suggests that the distributions of sex and body composition were comparable between the two groups. The intervention was conducted more often on the right hip in the OA group (70%) compared to the RP group (50%). This difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.042), suggesting a slight preference for the right side in the OA cohort. The comorbidities reported in the RP group were rheumatoid arthritis (38%), systemic lupus erythematosus (26%), juvenile rheumatoid arthritis (24%), and ankylosing spondylitis (10%). Less common comorbidities included antiphospholipid syndrome (6%), Sj\u0026ouml;gren's syndrome (4%), and Still's disease (4%). Most patients in the RP group received steroid treatment, and avascular necrosis of the femoral head was reported in 46% of these patients. Complication rates were low in both groups studied. The most common adverse event was aseptic loosening, which occurred in 28% of the OA group and 20% of the RP group. The second most frequent adverse event was polyethylene wear, with rates of 10% in the OA group and 8% in the RP group. The third most common adverse event was the need for revision surgery, which occurred at a rate of 6% in both groups. When comparing the two groups using student's t-test for binary variables, none of these differences were statistically significant. Additionally, infectious and neurological complications were rare, occurring in 4% or fewer cases. The complications between the groups are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were a few missing values (less than 5% for all variables), and they did not show a differential pattern between groups (p\u0026thinsp;=\u0026thinsp;0.27). The results after imputation and analysis of complete cases were similar. A few missing values (less than 5% for all variables), and they did not show a differential pattern between groups (p\u0026thinsp;=\u0026thinsp;0.27). The results after imputation and analysis of complete cases were comparable.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComplications related to THA between study groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOA group (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRP group (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeptic loosening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAseptic loosening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriprosthetic fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriprosthetic dislocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRevision surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyethylene wear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriprosthetic infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSciatic nerve injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFrequency of complications reported between groups, and the P-value was estimated using the student\u0026rsquo;s t-test for binary variables\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents a summary of the preoperative and postoperative changes in HHS, WOMAC, and NRS for the two study groups. For each variable, we provide the mean and SD before and after surgery, the mean difference between the two phases (Δ\u0026thinsp;=\u0026thinsp;postoperative - preoperative) along with its 95% CI, the p-value from the paired t-test, and the Cohen's d effect size. In scales as HHS a higher value indicates a better status, positive Δ and d values signify an improvement. Conversely, in scales where a lower value reflects a better outcome (such as WOMAC and NRS), negative Δ and d values indicate improvement. The magnitude of the treatment effect was estimated using Cohen's d. A magnitude of 0.2\u0026ndash;0.5 indicates a small effect, 0.5\u0026ndash;0.8 indicates a moderate effect, 0.8\u0026ndash;1.2 indicates a large effect, and greater than 1.2 indicates a very large effect\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFunctional and pain scores between the two study groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFuntional and pain outcomes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eΔ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIC 95% Δ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCohen d\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHHS\u003c/p\u003e \u003cp\u003e(OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e34.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e79.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e42.4\u0026ndash;48.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHHS\u003c/p\u003e \u003cp\u003e(RP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e86.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49.6\u0026ndash;56.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWOMAC (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e78.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e30.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-47.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-52.8\u0026ndash;-42.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-2.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWOMAC\u003c/p\u003e \u003cp\u003e(RP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e76.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-51.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-54.2\u0026ndash;-48.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-5.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS\u003c/p\u003e \u003cp\u003e(OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-6.3\u0026ndash;-5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-3.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS\u003c/p\u003e \u003cp\u003e(RP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-8.2\u0026ndash;-7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-4.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe magnitude of the treatment effect (Cohen's d) were greater than or equal to 2 for the WOMAC and NRS and greater than or equal to 4 for the HHS. These values indicate substantial improvements.\u003c/p\u003e \u003cp\u003eThe HHS scale increased by approximately 48 points in the OA group and 54 points in the RP group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These values are six to seven times the usual clinically important difference of seven points or more, and their Cohen's effect sizes are classified as \"huge,\" indicating that virtually all patients moved from severe disability to nearly normal function. WOMAC scores decreased by approximately 45\u0026ndash;51 points in both groups, with a Cohen's d effect size of at least 2.0. NRS pain scores decreased in both groups, with the decrease being much greater than the MCID of 1.5. Negative WOMAC and NRS values reflect improvement since lower numbers on these scales indicate less pain and disability. Comparing the groups shows better results in the WOMAC, HHS, and NRS scales. This means that these patients obtain an additional functional and analgesic advantage in the long term.\u003c/p\u003e \u003cp\u003eTo assess health-related quality of life, the health assessment consists of eight dimensions and each domain is scored from 0 to 100, with higher scores indicating better health. Significant increases were observed in both groups from the preoperative phase to the 20-year measurements. According to Cohen's conventional categories, the effect sizes indicated notable and clinically relevant gains, ranging from 1.11 in emotional well-being for the OA group to 10.75 in physical functioning for the RP group. The domains that showed the most remarkable absolute change were physical functioning and role-physical, which demonstrated the greatest improvement. The RP group achieved slightly higher postoperative values for physical functioning (97.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0) compared to the OA group (92.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6). In the role-physical domain, both groups experienced substantial gains, although the increase was slightly greater in the OA group. The energy and general health dimensions showed more modest differences; however, the changes remained statistically and clinically significant. At 20 years, the median score for most domains was above 80, indicating the maintenance of excellent function and quality of life. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e report the SF-36 evaluation between the two study groups in the preoperative vs postoperative outcomes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSF-36 outcomes between both study groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eΔ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCohen\u0026acute;s d\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical functioning (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e92.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical functioning (PR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e97.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRole physical (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e95.5\u0026thinsp;\u0026plusmn;\u0026thinsp;20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRole physical (PR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e100.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRole emotional (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e95.3\u0026thinsp;\u0026plusmn;\u0026thinsp;20.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRole emotional (PR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e100.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnergy (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e65.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnergy (PR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e56.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e71.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional well-being (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e55.3\u0026thinsp;\u0026plusmn;\u0026thinsp;20.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e82.4\u0026thinsp;\u0026plusmn;\u0026thinsp;17.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional well-being (PR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e64.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e86.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial functioning (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;22.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75.8\u0026thinsp;\u0026plusmn;\u0026thinsp;20.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial functioning (PR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e96.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e27.4\u0026thinsp;\u0026plusmn;\u0026thinsp;24.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e81.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain (PR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e94.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral health (OA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e65.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral health (PR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e50.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePositive Δ values indicate an increase, while negative Δ values suggest a decrease (improvement) on scales where a higher score reflects a worse status, such as WOMAC and VAS. The P value was calculated using paired t-tests, and Cohen's d was used to interpret the effect size, with 0.2 considered small, 0.5 moderate, and 0.8 large.\u003c/p\u003e \u003cp\u003eA stepwise approach was employed to evaluate the impact of diagnosis on prosthetic function and survival. Initially, crude means of functional scores and the raw risk of revision were compared. Subsequently, models were adjusted for age (\u0026le;\u0026thinsp;65/\u0026ge;65 years), sex, BMI (\u0026le;\u0026thinsp;30/\u0026ge;30 kg/m\u0026sup2;), and year of surgery. Finally, hazard ratios were converted into absolute odds ratios using Kaplan-Meier curves. In the unadjusted analysis, patients with rheumatologic conditions scored 9.3 points higher on the physical component of the SF-36 compared to those with osteoarthritis (95% CI: 4.1\u0026ndash;14.5; p\u0026thinsp;=\u0026thinsp;0.001). They also demonstrated advantages of 7.2 points on the WOMAC (95% CI: 2.5\u0026ndash;11.8) and 6.5 points on the HHS (95% CI: 1.9\u0026ndash;11.1). After multivariate adjustments, clinically relevant differences persisted: +8.9 points on the SF-36 (95% CI: 3.2\u0026ndash;14.6), +\u0026thinsp;6.8 points on the WOMAC (95% CI: 2.1\u0026ndash;11.5), and +\u0026thinsp;6.1 points on the HHS (95% CI: 1.5\u0026ndash;10.7). The hazard ratio for any revision was found to be 1.28 (CI: 0.73\u0026ndash;2.24) in the crude model and 1.23 (CI: 0.70\u0026ndash;2.16) following adjustments. This supported the proportional hazards assumption (Schoenfeld residuals: p\u0026thinsp;\u0026gt;\u0026thinsp;0.10). The cumulative probability of revision was 12% at 10 years and 18% at 20 years for osteoarthritis, compared to 9% and 14%, respectively, for rheumatologic conditions. These absolute differences were 3% and \u0026minus;\u0026thinsp;4%, respectively, affirming that there is no detrimental effect on implant survival for patients with inflammatory diseases despite their superior functional performance.\u003c/p\u003e \u003cp\u003eA radar plot showing the postoperative results of the OA group is in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and the postoperative results of the RP group are in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, where preoperative results were reported in blue and the postoperative results in orange.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe radar plot of SF-36 scale results reports a better perception of the general health of this group, and we can observe that baseline pain between groups is similar.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRadar plot of SF-36 scale results reports role limitations in emotional problems, energy, social functioning, pain, and general health in the postoperative stage.\u003c/p\u003e \u003cp\u003eAfter 30 years, both groups reported excellent results. However, patients with RP have a slight advantage in terms of function, energy, social interaction, and residual pain. Patients in OA group tend to have a more positive perception of their overall health. The physical functioning dimension of the SF-36 survey reported a marginal advantage for the RP group. Additionally, the energy and social functioning dimensions are significantly higher for the RP group. Notably, the general health dimension is 15 points lower in the RP group, indicating a less favorable self-perception of overall health despite better functioning and lower pain levels. The remaining dimensions: role physical, role-emotional, emotional well-being, and pain did not show clinically relevant differences. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the differences between pathologies (OA versus PR) following surgery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of SF-36 differences between pathologies after surgery.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean OA group\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean RP group\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Δ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIC 95%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHedge's g\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLevene's test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical functioning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e92.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e97.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.0\u0026ndash;8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRole physical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e95.5\u0026thinsp;\u0026plusmn;\u0026thinsp;20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e100.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.1\u0026ndash;10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRole emotional\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e95.3\u0026thinsp;\u0026plusmn;\u0026thinsp;20.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e100.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.0\u0026ndash;10.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnergy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e65.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e71.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.1\u0026ndash;10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotional well-being\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e82.4\u0026thinsp;\u0026plusmn;\u0026thinsp;17.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e86.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.1\u0026ndash;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial functioning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e75.8\u0026thinsp;\u0026plusmn;\u0026thinsp;20.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e96.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.9\u0026ndash;26.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e81.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e94.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.6\u0026ndash;17.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeneral health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e65.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e50.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-20.8\u0026ndash;-9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe values for each domain were compared using Student's t-test for independent samples. The results include the mean \u003cb\u003eΔ\u003c/b\u003e (difference between pathologies), its 95% confidence interval, the P-value, and the effect size (Hedges g). An effect size of g\u0026thinsp;\u0026ge;\u0026thinsp;0.5 was considered clinically significant.\u003c/p\u003e \u003cp\u003eIn the 20-year intergroup comparison, patients in the RP group reported higher scores in six out of the eight SF-36 domains. These differences were statistically and clinically significant in the areas of energy (\u0026gt;\u0026thinsp;6.0 points; g\u0026thinsp;=\u0026thinsp;0.60), social functioning (\u0026gt;\u0026thinsp;20.8 points; g\u0026thinsp;=\u0026thinsp;1.38), and pain (\u0026gt;\u0026thinsp;12.7 points; g\u0026thinsp;=\u0026thinsp;0.98). The difference in physical functioning was borderline significant, with a score of 4.3 points (p\u0026thinsp;=\u0026thinsp;0.051). No differences were observed in the physical or emotional role scales between the groups. The general health domain favored the osteoarthritis group. Overall, these results suggest that patients with RP maintain or even exceed the quality of life seen in patients with OA, especially regarding pain and social participation, though they reported lower global health perception.\u003c/p\u003e \u003cp\u003eThe cumulative probability of remaining free from revision was high and comparable between the two groups: for the OA group, it was 93.8% at 10 years and 90.6% at 30 years; for the PR group, it was 97.8% at 10 years and 93.2% at 30 years. The log-rank test indicated no significant differences between the two curves (p\u0026thinsp;=\u0026thinsp;0.78). Additionally, the adjusted Cox model showed a hazard ratio (HR) of 1.08 (95% CI, 0.24\u0026ndash;4.86; p\u0026thinsp;=\u0026thinsp;0.92). Survival of patients who underwent THA are reported in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eKaplan-Meier curve illustrating the cumulative probability of remaining revision-free after THA. At 10 years, the survival rate was 98%; at 20 years, it was 93%, and the rate remained unaffected by new events until the 30-year follow-up.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTHA is the treatment of choice for patients with severe joint damage. It is considered the surgery of the century because it restores mobility and reduces pain. The most common indication is OA, followed by RP with inflammation and severe joint involvement (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In patients with RP, the medical treatment is pharmacological, with the use of non-steroidal anti-inflammatory drugs, glucocorticoids, immunosuppressants, and disease-modifying antirheumatic drugs; however, a low percentage of patients report after glucocorticoid treatments\u0026rsquo; avascular necrosis of the femoral head (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). As we can observe, both study groups presented similar complications, such as aseptic loosening and polyethylene wear. On the other hand, RP patients presented a higher frequency of revision surgery, in addition to being younger patients and exposed to greater mobility due to their greater wear, which is related to young patients after THA (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Therefore, throughout the history of THA, surgical protocols have been performed to restore mobility and quality of life towards 2030 and to the future and avoid complications related with THA (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe bibliography widely reports functionality in patients diagnosed with OA. Conversely, patients with limitations, such as patients with RP, become essential in recovering mobility and quality of life (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In our study, we reported improvement in the HHS and WOMAC index in both study groups; we reported better postoperative results in the RP groups, consistent with the literature regarding mobility and functionality after THA, even in patients with chronic inflammatory pathologies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). THA demonstrated significant improvements in pain and function for both groups, surpassing the MCID by a considerable margin. Nevertheless, patients with RP enjoyed additional long-term functional and pain relief benefits.\u003c/p\u003e \u003cp\u003eThe SF-36 health facilitates cost-effectiveness analysis. Indeed, its use has been reported in young patients, and its daily use is in the postoperative course (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In both groups, we observed a statistically and clinically significant increase in all SF-36 domains, with a particular emphasis on mental health; after surgery, the mental health and vitality scores were above 80% of the maximum possible, indicating an overall positive emotional state following THA. Notable improvements were seen in the RP group across several domains, including limitations due to emotional problems, energy/vitality, social function, bodily pain, and general health, with effect sizes (d) of 1.0 or greater. This suggests that there is an additional psychological benefit that accompanies functional recovery. Since RP patients typically face greater sarcopenia, mobility restrictions, and severe pain, the reduction in pain and the improvement in function following THA may help explain the extent of their emotional enhancement. The literature indicates that preoperative psychosocial factors such as anxiety, depression, pain catastrophizing, and low self-esteem are linked to poorer postsurgical satisfaction. However, in our cohort, it appears that surgical intervention helps mitigate these negative predictors, as demonstrated by the significant improvements in mental health domains.\u003c/p\u003e \u003cp\u003eIn 2020, Pallante et al. and Melissa et al. (2017) reported comparable survival rates after THA in patients younger than 12 years (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). A meta-analysis by Evans et al. in 2019 found that the 12-year survival rate is 98% for men and 93% for women under 50 years of age. These results align closely with those of Chang et al. in 2020, which showed a survival rate of 89.4% at 15 years, 70.2% at 20 years, and 57.9% at 25 years among patients who underwent THA (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). According to the Mayo Clinic, studies of patients younger than 20 years with a clinical follow-up of 20 years revealed a survival rate with a revision of 97.2% at 10 years, based on data from 138 patients treated between 1998 and 2016 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, our findings indicate that the survival rates observed in this study are higher than those reported in previous research.\u003c/p\u003e \u003cp\u003eSignificant improvements in health-related quality of life were observed across all domains. The RP group experienced additional benefits in emotional well-being, vitality, social functioning, and bodily pain, indicating psychological and social advantages alongside physical relief. These findings demonstrate that THA has a clinically significant impact on pain, function, and overall health, regardless of the underlying cause of the condition.\u003c/p\u003e \u003cp\u003eThe limitations of the study arise from its execution in a tertiary-level hospital, which may have introduced bias by enrolling only patients with complex pathologies. This selection bias is rooted in the inclusion criteria, specifically designed to accommodate individuals with complex conditions requiring specialized treatments. Consequently, it is crucial to recognize that the results may not be easily generalizable to less specialized care settings with larger, more diverse patient populations. Despite the availability of advanced resources at this hospital, the study did not make comparisons with less complex cohorts or institutions at different levels of care. Furthermore, three reconstruction surgeons at this facility have followed relatively consistent protocols and employed similar technologies for the past three decades. As such, the outcomes documented here may be more applicable to hospitals with comparable expertise and resources, particularly specialized units equipped with systematic follow-up and access to formal rehabilitation. This is particularly relevant for Latin America and other regions with similar demographic profiles, especially adults aged 45 to 80 years, with a predominance of females and moderate levels of comorbidity. Additionally, the use of cross-culturally validated outcome instruments (such as the SF-36, WOMAC, and HHS) enhances the international comparability of functional outcomes. Several limitations should be considered: First, the implants and perioperative antibiotics used during the study period may have changed and differ from those available today in lower-volume centers. Second, the 1:1 purposive sampling (50 patients with OA and 50 with RP ensures analytical balance but does not accurately represent the actual proportions of these conditions in clinical practice. Third, Mexico's public health system provides coverage for hospital stays and rehabilitation that might not be available in private insurance systems or regions with limited resources. Therefore, caution should be exercised when applying these results to low-volume hospitals, populations with different ethnic backgrounds, or shortened rehabilitation programs. Whenever possible, these findings should be validated with contemporary multicenter studies.\u003c/p\u003e \u003cp\u003eIn summary, THA offers durability of 30 years or more, along with notable improvements in functional and pain relief for patients with OA and those in the RP group. Despite starting from a position of greater frailty, the RP group enjoys extra benefits in terms of both physical and emotional well-being. A thorough evaluation using the HHS, WOMAC, NRS, and the SF-36 confirms that the success of the intervention extends beyond mere joint mobility and positively influences overall health and long-term quality of life.\u003c/p\u003e \u003cp\u003eTo achieve an excellent postoperative outcome, it is essential to optimize both the physical and emotional aspects before and after surgery. The ultimate goal is to enhance patients' quality of life.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study examined patients with RP and OA and found that THA can demonstrate remarkable durability, providing sustained benefits for up to 30 years. The revision-free survival rate exceeded 90% in both patient groups, indicating that a rheumatic etiology does not impact the longevity of prosthetic implants. Functionally, the HHS improved by an average of 48 points for OA patients and 54 points for RA patients. Additionally, the WOMAC score decreased by 45 to 51 points. The pain NRS score fell significantly below the MCID, exhibiting effect sizes (d\u0026thinsp;\u0026ge;\u0026thinsp;2). This indicates a shift from severe disability to nearly normal function. The SF-36 scale also showed significant improvements across all domains, with RA patients experiencing extra benefits in vitality, social functioning, and bodily pain, highlighting the importance of the emotional aspect of recovery. These findings emphasize that to maximize functional gains, pain relief, and patient satisfaction, THA should be complemented by physical and psychosocial optimization strategies both before and after surgery. By incorporating a multidimensional assessment and extended follow-up in a Latin American population, our study provides strong evidence that hip arthroplasty is a durable and transformative intervention, particularly when approached in a multidisciplinary mode.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI: Body Mass Index\u003c/p\u003e \u003cp\u003eCI: Confidence Interval\u003c/p\u003e \u003cp\u003eHHS: Harris Hip Score\u003c/p\u003e \u003cp\u003eHR: Hazard ratio\u003c/p\u003e \u003cp\u003eHRQoL: health-related quality of life\u003c/p\u003e \u003cp\u003eICC: intraclass correlation coefficient\u003c/p\u003e \u003cp\u003eMCAR: missing data were completely at random\u003c/p\u003e \u003cp\u003eMCID: minimum clinically important difference\u003c/p\u003e \u003cp\u003eMOS: Medical Outcomes Study\u003c/p\u003e \u003cp\u003eOA: osteoarthritis\u003c/p\u003e \u003cp\u003eRP: Rheumatic Pathologies\u003c/p\u003e \u003cp\u003eSD: Standard deviation\u003c/p\u003e \u003cp\u003eSF-36: Short Form 36 Health Survey.\u003c/p\u003e \u003cp\u003eTHA: Total Hip Arthroplasty\u003c/p\u003e \u003cp\u003eWOMAC: Western Ontario and McMaster Universities Osteoarthritis index\u003c/p\u003e \u003cp\u003eΔ: The magnitude of the difference\u003c/p\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003eEthics approval and consent to participate\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eApproval for this study was obtained from the Institutional Review Board at the Instituto Nacional de Ciencias M\u0026eacute;dicas y Nutricion Salvador Zubiran. (registration\u0026nbsp;CONBIOETICA- A-09-CEI-011-20160627, official letter\u0026nbsp;OFICIO-NO. MCONTROL-1467/2023). Our research was conducted in accordance with the Declaration of Helsinki and the Mexican national guidelines for health research in humans (NOM-012-SSA3-2012). All participants provided written informed consent before enrolling in the study.\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003eConsent for publication\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eNot applicable. The manuscript does not contain any individual person\u0026rsquo;s data.\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003eAvailability of data and materials\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe datasets generated during and analyzed during the current study are available in the Zenodo repository, available from:\u0026nbsp;https://zenodo.org. DOI 10.5281/zenodo.15664128.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003eCompeting interests\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003col start=\"5\"\u003e\n \u003cli\u003eFunding\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe authors declare that they have no sources of funding for the research reported in this study. \u0026nbsp;\u003c/p\u003e\n\u003col start=\"6\"\u003e\n \u003cli\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eVirginia Elizabeth Macias Mosquera. Contribution: Data Curation\u003c/p\u003e\n\u003cp\u003eLuis David Marcial Barba. Contribution: Supervision\u003c/p\u003e\n\u003cp\u003eDiego Laverde Osorio. Contribution: Data Curation\u003c/p\u003e\n\u003cp\u003eEfrain Diaz Borjon. Contribution: Conceptualization\u003c/p\u003e\n\u003cp\u003eJuan Montejo Vargas. Contribution: Writing - Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eGeorges Jirjis Makdissy Salomon. Contribution: Writing - Original Draft\u003c/p\u003e\n\u003cp\u003eChristian Hazel Hernandez Romero. Contribution: Methodology\u003c/p\u003e\n\u003col start=\"7\"\u003e\n \u003cli\u003eAcknowledgements\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eWe would like to thank the Department of Rheumatology at our medical unit, with whom we collaborated to develop reliable research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMarkatos K, Savvidou OD, Foteinou A, Kosmadaki S, Trikoupis I, Goumenos SD, et al. Hallmarks in the history and development of total hip arthroplasty. 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The impact of pre-operative opioid use on outcomes after total knee arthroplasty: a prospective cohort study. J Bone Joint Surg Am. 2023;105(17):1492\u0026ndash;500. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2106/JBJS.23.00123\u003c/span\u003e\u003cspan address=\"10.2106/JBJS.23.00123\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRies MD. Relationship between functional anatomy of the hip and surgical approaches in total hip arthroplasty. Orthopedics. 2019;42(4):e356\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/01477447-20190624-03\u003c/span\u003e\u003cspan address=\"10.3928/01477447-20190624-03\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDimitriou D, Antoniadis A, Flury A, Liebhauser M, Helmy N. Total hip arthroplasty improves the quality-adjusted life years in patients who exceeded the estimated life expectancy. J Arthroplasty. 2018;33(11):3484\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arth.2018.07.005\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2018.07.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDataset. Hern\u0026aacute;ndez-Romero CH, et al. Dataset for: Evaluation of general health status in total hip arthroplasty patients, 30-year cohort study. Zenodo. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5281/zenodo.15664128\u003c/span\u003e\u003cspan address=\"10.5281/zenodo.15664128\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"hip arthroplasty, functionality, physical health, well-being, satisfaction, survival","lastPublishedDoi":"10.21203/rs.3.rs-6895475/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6895475/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Total hip arthroplasty (THA) is the primary treatment for severe joint damage and represents a significant surgical advancement of the century. This study aims to evaluate the long-term health-related quality of life (HRQoL) of THA patients, based on a remarkable follow-up period of 30 years after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This is a retrospective comparative cohort study in Latin American population. The cohort includes all THA performed between January 1, 1990, and December 31, 2020. A total of 458 patients from this database were evaluated, with a follow-up period of 30 years. Our population showed a high frequency of patients with rheumatoid pathologies (RP); therefore, we performed a simple random sampling to balance the number of cases for comparison between the two study groups: the osteoarthritis (OA) group and the RP group. For functional assessment, the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used. At the same time, pain was assessed using a Numeric Rating Scale (NRS). THA survival was evaluated using the Kaplan-Meier method and to assess HRQoL with the Short Form 36 Health Survey (SF-36). A p-value of less than 0.05 was considered statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: THA positively affects pain relief, physical function, mental health, and social participation. To achieve an excellent postoperative outcome, it is essential to optimize both the physical and emotional aspects before and after surgery. The ultimate goal is to enhance patients' quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: THA should be complemented by physical and psychosocial optimization strategies both before and after surgery, incorporating a multidimensional assessment and extended follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eNot applicable, this study is an observational retrospective cohort; no prospective registration was required.\u003c/p\u003e","manuscriptTitle":"Evaluation of general health status in total hip arthroplasty patients, 30- year cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-24 12:38:54","doi":"10.21203/rs.3.rs-6895475/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6342e00f-7299-4e26-9684-ce961e1f6ccb","owner":[],"postedDate":"June 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-24T11:23:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-24 12:38:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6895475","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6895475","identity":"rs-6895475","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}