"Exploring the Impact of Preoperative Radiographic Arthritis Severity on Total Hip Arthroplasty Outcomes" Can patients with less radiographic hip disease still do well after a THA?

"Exploring the Impact of Preoperative Radiographic Arthritis Severity on Total Hip Arthroplasty Outcomes" Can patients with less radiographic hip disease still do well after a THA? | 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 "Exploring the Impact of Preoperative Radiographic Arthritis Severity on Total Hip Arthroplasty Outcomes" Can patients with less radiographic hip disease still do well after a THA? Isabella Amado, Ryan Bialazewski, Bretton Laboret, John Gaddis, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4189232/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 As total hip arthroplasty (THA) indications continue to expand and longevity increases, it is important to understand the outcomes in different patient populations. Younger, more active patients are electing to proceed with THA with differing severity of disease. We aimed to investigate patient reported outcome measures (PROMs) in patients who underwent THA with less severe radiographic hip arthrosis. Methods Pre- and post-operative PROMs and radiographic data (joint-space width, Tonnis grade) for patients undergoing THA between 9/16/2016 and 10/21/2021 by a single surgeon were collected. Baseline Tonnis grades were stratified, and PROMs, including Harris Hip Score (HHS), Hip Outcome Score (HOS), and Short-Form-12 Scale (SF-12), were compared pre- and post-operatively. Results Four-hundred and sixty-two hips underwent analysis. Pre-operative HHS following THA were ​​46.6 ± 11.9, 47.5 ± 11.4, 44.4 ± 9.6, and 42.1 ± 10.7 for Tonnis grades 0 (n = 27), 1 (n = 56), 2 (n = 73), and 3 (n = 306), respectively; while post-operative HHS were 86.4 ± 7.8, 88.4 ± 7.7, 89.5 ± 4.4, and 88.7 ± 5.4 Higher postoperative HOS scores were seen in Tonnis grade 0 and 1, when compared to Tonnis grades 2, and 3 (49.1 ± 27.9, and 50.1 ± 20.8 vs. 47.0 ± 22.2, and 44.0 ± 22.2, respectively; p = 0.003), however, no statistical difference was seen in mean difference HOS (p = 0.447). For SF-12, the mean improvement in order of increasing Tonnis grades was 16.7 ± 48.7, 9.2 ± 38.3, 6.6 ± 43.4, and 14.9 ± 45.2 with no statistical significance observed (p = 0.565). Conclusion In patients undergoing THA, post-operative HHS scores are similar regardless of baseline radiographic severity. Post-operative change in HOS and SF-12 scales was consistently higher across all baseline Tonnis grades prior to THA, while mean change remained comparable. These findings suggest although preoperative radiographic data aids in the evaluation of patients with hip pain, the severity of findings should not determine surgical candidacy. This study challenges radiographic severity for THA eligibility and adds to THA literature for those with less severe radiographic findings. Total hip arthroplasty arthritis THA PROMs Figures Figure 1 Figure 2 Background Outcomes following THA can be highly variable and may be influenced by radiographic severity at baseline 1 , 2 . Some studies suggest that the aim of surgery should be to correct radiographic abnormalities, while others argue that improving quality of life measures should be the primary goal 3 , 4 , 5 , 6 , 7 , 8 . It remains questionable, however, if patients with continued hip pain despite conservative measures and less radiographic severity should undergo THA, and if their outcomes will be equivalent to those with severe radiographic disease. In patients with osteoarthritis, the severity of arthritis, as measured by radiographic joint space, can vary at symptom onset. Some patients may experience minimal pain despite severe radiographic arthritis, while others may have severe pain with minimal radiographic findings 8 . The relationship between OA severity and symptomatology may be associated with various factors, including weight, age, sex, activity level, and psychological status 9 , 10 , 11 . To address this gap in the literature, this study aims to examine if radiographic severity of arthritis prior to THA impacts post-operative patient-reported hip outcome measures. Radiographic severity will be measured using joint space width and Tonnis Grade. By assessing the impact of radiographic severity on post-operative outcomes, this study seeks to provide valuable insights into the decision-making process for offering THA to patients with varying degrees of radiographic disease severity. Overall, this study aims to contribute to the existing body of knowledge on THA outcomes and inform clinical practice regarding the selection of patients for surgery based on radiographic severity. Patients and Methods Study Design and Setting This was a retrospective HIPAA-compliant study approved by the institutional review board. Patients Inclusion criteria for our study included all patients undergoing THA by a single surgeon between 09/01/2016 and 10/31/2021. Eight-hundred and eighty hips met inclusion criteria and were retrospectively reviewed. Exclusion criteria included lack of preoperative or postoperative survey completion, less than a minimum of one-year postoperative follow-up, and lack of pre-operative radiographs. Four hundred and sixty-two hips were analyzed in the study after applying the exclusion criteria (Fig. 1 ). Demographics collected for our study population include sex, age, height, weight, and body mass index (BMI). Additional factors reported for each hip include surgical approach 12 , laterality, length of follow-up, and joint space width. Imaging Protocol Imaging was done under standardized protocol. All patients received a standing AP pelvis radiograph and cross table lateral from the same radiographic center. Imaging Analysis The analysis involved the assessment of joint space width, which was performed by four medical students under the guidance of an experienced orthopedic surgeon. A comprehensive training session was conducted to establish a uniform understanding and interpretation of observation criteria to reduce the potential bias introduced by the researchers. Joint space width was determined by measuring the narrowest section of the joint between the femoral head and acetabulum to the nearest tenth of a millimeter (Fig. 2 ). Radiographs with loss of joint space secondary to severe arthritis leading to bone-on-bone contact were recorded as having 0 mm of joint space. Radiographic Severity Grading Tönnis grading was used to further classify the degree of osteoarthritis. These were all calculated by a single orthopaedic surgeon who has extensive knowledge and expertise in the field 13 , 14 . The Tönnis grading is a standardized method of classifying OA consisting of three progressive degrees of degenerative changes to the hip 15 . The score ranges from 0–3, with 0 indicating hip absence of arthrosis and 3 being the most severe, indicating severe narrowing of the joint space, moderate loss of femoral head sphericity, large cysts and/or avascular necrosis (Table 1 ). No additional studies, such as diagnostic hip injections or other imaging, were used to confirm the diagnosis. Table 1 Tönnis grading scale of hip osteoarthritis. Grade Radiographic features 0 No signs of osteoarthritis 1 Slight narrowing of joint space Slight lipping at joint margin Slight sclerosis of the femoral head or acetabulum 2 Small cysts in the femoral head or acetabulum Increasing narrowing of joint space Moderate loss of sphericity of the femoral head 3 Large cysts Severe narrowing or obliteration of joint space Severe deformity of femoral head Avascular necrosis Patient-Reported Outcomes Measurements (PROM) PROMs were evaluated before and after surgery. Pre-operative surveys were administered at the initial visit, while post-operative surveys were given at each follow up visit with intervals on six weeks, six months, one year, two years, and three years. The most recent post-operative surveys were used for each patient, while those with less than one year follow up surveys were excluded from the study. The Harris Hip Score (HHS), Hip Outcome Score (HOS), Short-Form-12 Scale (SF-12) were assessed (Table 2 ). All outcome measures have been previously validated 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 . Table 2 Patient-reported outcome measures. Outcome Measure Scale Response Harris Hip Score 0-100 Higher score indicates better health status HOS Score 0-100 Higher score indicates higher function Short-Form-12 scale 0-100 Higher score indicates better health status Statistical Methods Patient demographics for the sample of 462 patients with a range of Tonnis grades (0–3), diagnoses, preoperative PROMs, postoperative PROMs, and delta change for each PROM were reported using the sample mean and standard deviation for continuous variables and count and percentage for categorical variables. Statistical analyses were carried out using Statistical Package for the Social Sciences (SPSS) software. The level of significance was set at α = 0.05 (two-tailed). Results A total of 462 hips were included in this study, with a mean age of 61.1 ± 15.2 years. Of these, 269 (58.2%) were female and 193 (41.8%) were male. The mean BMI was 28.6 ± 5.8 kg/m 2 , and the mean follow-up time was 680.2 ± 282.7 days. The preoperative radiographic severity scores were graded based on Tonnis grades with 27 hips graded 0, 56 graded 1, 73 graded 2, and 306 graded 3 (Table 3 ). Preoperative diagnoses were assessed, those with a higher Tonnis grade were predominantly diagnosed with OA (Table 4 ). Table 3 Additional patient factors compared to Tonnis grade. Tonnis Grade 0 (n = 27) 1 (n = 56) 2 (n = 73) 3 (n = 306) All (n = 462) p-value Baseline Characteristics Age (yrs.) Female sex Male sex Height Weight BMI (kg/m 2 ) 52.6 ± 17.3 13 (48.1%) 14 (51.9%) 67.3 ± 4.8 164.2 ± 37.3 25.4 ± 5.2 50.9 ± 15.0 39 (69.6%) 17 (30.4%) 66.2 ± 3.7 173.3 ± 39.5 27.9 ± 6.4 60.2 ± 16.2 44 (60.3%) 29 (39.7%) 67.0 ± 4.1 183.7 ± 42.0 28.7 ± 5.6 64.0 ± 13.6 173 (56.5%) 133 (43.5%) 67.3 ± 4.6 187.4 ± 45.2 29.0 ± 5.8 61.1 ± 15.2 269 (58.2%) 193(41.8%) 67.1 ± 4.4 183.8 ± 44.0 28.6 ± 5.8 <0.0010.204 0.204 0.234 0.001 0.004 Mean follow-up (days) 636.0 ± 226.5 636.2 ± 259.4 691.0 ± 293.4 689.6 ± 288.7 680.2 ± 282.7 0.165 Laterality Right hips (n) Joint space width (mm) Left hips (n) Joint space width (mm) 16 (59.3%) 3.4 ± 1.3 141(40.7%) 3.2 ± 1.0 35 (62.5%) 2.5 ± 1.3 21 (37.5%) 3.0 ± 1.2 38 (52.1%) 1.9 ± 1.4 35 (47.9%) 2.1 ± 1.5 170 (55.6%) 1.2 ± 1.4 136 (44.4%) 1.4 ± 1.5 259 (56.1%) 1.6 ± 1.5 203 (43.9%) 1.9 ± 1.5 0.670 < 0.001 0.670 < 0.001 Surgical approach Anterior Posterior Complex 18 (66.7%) 9 (33.3%) 0 (0.0%) 31 (55.4%) 24 (42.9%) 1 (1.8%) 37 (50.7%) 30 (41.1%) 6 (8.2%) 137 (45.1%) 157 (51.6%) 10 (3.3%) 223 (48.5%) 220 (47.8%) 17 (3.7%) 0.065 0.065 0.065 Table 4 Hip pathology diagnoses based on Tonnis grade. Tonnis Grade 0 (n = 27) 1 (n = 56) 2 (n = 73) 3 (n = 306) All (n = 462) p-value Osteoarthritis 0 (0.0%) 0 (0.0%) 61 (83.6%) 241 (78.8%) 302 (65.4%) < 0.001 Hip Dysplasia 10 (37.1%) 39 (69.6%) 0 (0.0%) 0 (0.0%) 49 (10.6%) < 0.001 Osteonecrosis 11 (40.7%) 6 (10.7%) 6 (8.2%) 44 (14.4%) 67 (14.5%) < 0.001 Perthes 0 (0.0%) 3 (5.4%) 3 (4.1%) 1 (0.3%) 7 (1.5%) < 0.001 Post-traumatic 0 (0.0%) 2 (3.6%) 3 (4.1%) 8 (2.6%) 13 (2.8%) < 0.001 Femoral acetabular impingement 0 (0.0%) 3 (5.4%) 0 (0.0%) 0 (0.0%) 3 (0.6%) < 0.001 Inflammatory arthritis 0 (0.0%) 0 (0.0%) 0 (0.0%) 8 (2.6%) 8 (1.7%) < 0.001 Acetabular protrusio 0 (0.0%) 3 (5.4%) 0 (0.0%) 0 (0.0%) 3 (0.6%) < 0.001 Multiple epiphyseal dysplasia 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (0.3%) 1 (0.2%) < 0.001 Hip fracture 6 (22.2%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 6 (1.3%) < 0.001 Native septic arthritis 0 (0.0%) 0 (0.0%) 0 (0.0%) 3 (1.0%) 3 (0.6%) < 0.001 Patient-reported outcome analysis demonstrates substantial improvement in HHS following THA, irrespective of initial Tonnis grades. HHS mean improvement by order of increasing Tonnis grade was 38.2 ± 11.7, 41.0 ± 12.6, 46.5 ± 10.4, 45.2 ± 10.8, respectively. Although these findings had a statistically significant difference in mean change of HHS scores, there was no notable difference in post-operative HHS following surgery (p = 0.164) (Table 5). Table 5 Preop, Postop, and delta change based on Tonnis grade. Tonnis Grade 0 (n = 27) 1 (n = 56) 2 (n = 73) 3 (n = 306) All (n = 462) p-value Harris Hip Score Preoperative Postoperative Net Change 46.6 ± 11.9 86.4 ± 7.8 38.2 ± 11.7 47.5 ± 11.4 88.4 ± 7.7 41.0 ± 12.6 44.4 ± 9.6 89.5 ± 4.4 45.1 ± 9.2 42.1 ± 10.7 88.7 ± 5.4 46.5 ± 10.4 43.4 ± 10.8 88.7 ± 5.8 45.2 ± 10.8 < 0.001 0.164 < 0.001 Hip Outcome Score Preoperative Postoperative Net Change 46.8 ± 26.3 49.1 ± 27.9 2.3 ± 9.8 48.7 ± 21.6 50.1 ± 20.8 1.3 ± 6.6 46.9 ± 22.1 47.0 ± 22.2 0.8 ± 6.6 40.9 ± 21.8 41.7 ± 21.7 1.0 ± 7.3 43.2 ± 22.2 44.0 ± 22.2 1.1 ± 7.3 0.007 0.003 0.447 Short-Form 12 Preoperative Postoperative Net Change 25.0 ± 32.8 43.5 ± 27.4 16.7 ± 48.7 29.2 ± 29.6 36.6 ± 22.3 9.2 ± 38.3 32.5 ± 33.2 39.7 ± 22.8 6.6 ± 43.4 25.5 ± 31.2 40.8 ± 25.1 14.9 ± 46.6 27.1 ± 31.5 40.3 ± 24.5 12.9 ± 45.2 0.504 0.681 0.565 HOS scores exhibited statistical significance, revealing higher postoperative HOS scores for Tonnis grade 0 (49.1 ± 27.9) and grade 1 (50.1 ± 20.8) in comparison to Tonnis grades 2 and 3 (p < 0.0001). However, the mean difference in HOS scores post-operatively failed to attain significance (p = 0.447). For SF-12, the mean improvement in order of increasing Tonnis grades was 16.7 ± 48.7, 9.2 ± 38.3, 6.6 ± 43.4, 14.9 ± 45.2. Irrespective of baseline Tonnis grade, no significance in pre-operative, post-operative, or mean difference values was observed (0.504, 0.681, and 0.565, respectively). Discussion Total hip arthroplasty is a widely utilized surgical treatment option for osteoarthritis of the hip, with good long-term outcomes 25 , 26 , 16 , 17 , 18 , 19 , 20 , 21 , 23 . However, few outcomes have been reported for patients undergoing THA with a lack of, or minimal, preoperative radiographic disease burden 23 , 24 , 25 , 26 , 27 , 28 , 29 . Our study is one of the largest databases of patients undergoing THA with minimal disease burden to our knowledge. Therefore, we aimed to define and analyze patient outcomes and compare these patients to those with significant radiographic disease. Our data suggests that patients with hip disease, irrespective of the severity of radiographic grading, can still improve after total hip arthroplasty. This study has limitations. First, this retrospective study represents a single surgeon’s experience with an emphasis on hip preservation surgery in a high-volume practice. This author (JW) is a technical expert, and as a single-surgeon series, this is a strength and weakness. The results obtained might not accurately reflect the experiences of low-volume practices, thus limiting the generalizability. Future research should consider utilizing larger sample sizes to enhance the applicability of our findings. This would greatly bolster the generalizability of our results, especially for high-volume joint centers where this study could serve as a valuable reference for guiding surgeons. Moreover, it's important to note that our study did not assess or correct intraoperative head and neck offset, nor did it analyze postoperative radiographs for head and neck offset during the initial surgical timeframe. Existing literature has demonstrated the significance of femoroacetabular impingement (FAI) following total hip arthroplasty (THA), which can significantly impact patient outcomes 30 . Unfortunately, we could not stratify our data to account for FAI-related impairments in this study. The relatively short follow-up period for joint arthroplasty should be considered, as longer follow-up periods provide a more comprehensive understanding of the intervention's effects over time. Our study had a mean follow-up time of 680 days, and we do not know if long-term follow-up timeframes will have similar patient outcomes between each group. Addressing these limitations through prospective designs, longer follow-up periods, and larger sample sizes would strengthen the validity of our findings and open avenues for further exploration. Another consideration for future research would be classifying outcomes based on a more sensitive imaging modality, such as magnetic resonance imaging (MRI). HHS and HOS have historically been the gold standard for quantifying patient outcomes following THA 16 , 17 , 18 , 19 , 20 , 21 . HHS domains covered are pain, function, absence of deformity, and range of motion, with scores ≥ 80 denoted as clinically accurate criteria for determining good patient outcomes 16 , 19 . HOS contains two domains, activities of daily living (ADL) and sports, that consist of 28 items 21 . There is no particular HOS score designating a good outcome; however, higher HOS scores represent a higher level of physical function for both the ADL and sports subscales 21 . We have shown that despite not having significant preoperative radiographic disease with preserved joint space, patients have improved HHS and HOS scores following THA. In addition, patients with less severe baseline radiographic findings had similar HHS and higher HOS metrics post-operatively when compared to those with more severe radiographic findings. Our results include a higher number of hips (83) undergoing primary THA without or with mild preoperative radiographic osteoarthritis (Tönnis Grade of 0–1) and directly contradict the findings when compared to the existing literature. Dowsey et al. reported on 382 primary THAs with varying levels of radiographic OA severity (modified Kellgren-Lawrence, mK-L) on the minimum difference (MID, as designated by half the standard deviation of the mean change) in pain and function scores at 1 and 2 years compared to baseline. Their results showed that odds ratios for THAs demonstrating a MID in pain and function scores with less severe baseline radiographic changes were significantly lower at 1 and 2 years than those with severe radiographic changes 30 . However, this study is limited by only having 4 patients with a mK-L severity of less than 3 (moderate osteoarthritis). Similarly, Tilbury et al. reported on 302 primary THAs, comparing hip disability and osteoarthritis outcome scores (HOOS) in patients with mild OA (n = 78) versus severe OA (n = 224) (Kellgren-Lawrence (KL) scores 0–2 vs. 3–4) 34 . Results were notable for lower degrees of change in HOOS for patients with mild OA; however, comparisons were not made on post-operative HOOS scores between the two groups, which is the aim of our study 34 . Additionally, Valdes et al. examined 928 post-THA patients and stated individuals with lower radiographic severity (n = 72) were more likely to experience higher pain postoperatively at a mean of 3.2 years 35 . Although we did not collect WOMAC pain data in this study, our data contradicts these findings when comparing HHS pain subscales between groups. Conclusion Our study did not find a significant relationship between preoperative radiographic OA severity scores based on Tönnis grade and outcomes after THA. All patients, regardless of their radiographic severity, improved following THA. This is an important finding, particularly for hips with low radiographic OA severity (Tönnis grades 0–1), as it suggests that these patients can achieve favorable outcomes similar to those with higher radiographic disease. PROMs were measured at set intervals, with 208 patients having a greater than 680-days follow-up period. While preoperative radiographic assessment remains crucial in evaluating candidates for THA, it is still important to determine the hip as the culprit of the symptomatology, no matter what stage of radiographic severity. A comprehensive workup for patients with hip disease should focus less on radiographic imaging findings and more on the patient’s history, physical examination findings, and co-morbidities when determining surgical candidacy. Future work may include the long-term outcomes for THA in patients with low radiographic OA severity and better stratification of radiographic OA severity with the use of MRI. Abbreviations THA: total hip arthroplasty PROMs: patient reported outcome measures HHS: Harris Hip Score HOS: Outcome Score SF-12: Short-Form-12 Scale OA: osteoarthritis BMI: body mass index SPSS: statistical package for the social sciences FAI: femoroacetabular impingement MRI: magnetic resonance imaging ADL: activities of daily living MID: minimum difference mK-L: modified Kellgren-Lawrence KL: Kellgren-Lawrence WOMAC: Western Ontario and McMaster Universities Arthritis Index Declarations Conflict of Interest Statement: The authors received no financial or material support for the research, authorship, and/or publication of this article. Ethics approval and consent to participate HIPAA-compliant study approved by the institutional review board (IRB). Informed consent was obtained from all subjects. University of Texas Southwestern Medical Center IRB number: STU 122016-058. Consent for publication Informed consent was obtained from all subjects. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no financial or material support for the research, authorship, and/or publication of this article. 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Acta orthopaedica, 92(6), 681–688. https://doi.org/10.1080/17453674.2021.1977533 Slavković, N., Vukašinović, Z., Baščarević, Z., & Vukmanović, B. (2012). Srpski arhiv za celokupno lekarstvo , 140 (5-6), 379–384. https://doi.org/10.2298/sarh1206379s Laferton, J. A. C., Oeltjen, L., Neubauer, K., Ebert, D. D., & Munder, T. (2022). The effects of patients' expectations on surgery outcome in total hip and knee arthroplasty: a prognostic factor meta-analysis. Health psychology review, 16(1), 50–66. Nilsdotter A-K, Aurell Y, Siösteen A-K, Lohmander LS, Roos HP. Radiographic stage of osteoarthritis or sex of the patient does not predict one year outcome after total hip arthroplasty. Ann Rheum Dis. 2001;60(3):228. Babiak-Vazquez AE, Cruz-Martinez R, Garza-Elizondo MA, Davila-Perez R, Davila-Gonzalez EO, Pena-Martinez VM, Martinez-Gaytan V. (2020). Correlation of radiographic severity and clinical outcomes in patients with knee osteoarthritis. Acta ortopedica mexicana, 34(3), 121-125. Van Meirhaeghe, J. P., Alarkawi, D., Kowalik, T., Du-Moulin, W., Molnar, R., & Adie, S. (2021). Predicting dissatisfaction following total hip arthroplasty using a Bayesian model averaging approach: Results from the Australian Arthroplasty Clinical Outcomes Registry National (ACORN). ANZ journal of surgery , 91 (9), 1908–1913. https://doi.org/10.1111/ans.17063 Kim C, Nevitt MC, Niu J, Clancy MM, Lane NE, Link TM, Vlad S, Tolstykh I, Jungmann PM, Felson DT, Guermazi A. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. Bmj . 2015 Dec 2;351. Dowsey MM, Nikpour M, Dieppe P, Choong PFM. Associations between pre-operative radiographic osteoarthritis severity and pain and function after total hip replacement. Clin Rheumatol. 2016;35(1):183–9. Chu Miow Lin, D., Reichmann, W. M., Gossec, L., Losina, E., Conaghan, P. G., & Maillefert, J. F. (2011). Validity and responsiveness of radiographic joint space width metric measurement in hip osteoarthritis: a systematic review. Osteoarthritis and cartilage , 19 (5), 543–549. https://doi.org/10.1016/j.joca.2010.12.014 Nilsdotter, A. K., Aurell, Y., Siösteen, A. K., Lohmander, L. S., & Roos, H. P. (2001). Radiographic stage of osteoarthritis or sex of the patient does not predict one year outcome after total hip arthroplasty. Annals of the rheumatic diseases , 60 (3), 228–232. https://doi.org/10.1136/ard.60.3.228 Vahedi, H., Yacovelli, S., Diaz, C., & Parvizi, J. (2021). Surgical Treatment of Femoroacetabular Impingement: Minimum 10-Year Outcome and Risk Factors for Failure. JB & JS open access , 6 (4), e20.00176. https://doi.org/10.2106/JBJS.OA.20.00176 Tilbury, C., Holtslag, M. J., Tordoir, R. L., Leichtenberg, C. S., Verdegaal, S. H., Kroon, H. M., Fiocco, M., Nelissen, R. G., & Vliet Vlieland, T. P. (2016). Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis. A prospective cohort study of 573 patients. Acta orthopaedica , 87 (1), 67–71. https://doi.org/10.3109/17453674.2015.1092369 Valdes, A. M., Doherty, S. A., Zhang, W., Muir, K. R., Maciewicz, R. A., & Doherty, M. (2012). Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty. Seminars in arthritis and rheumatism , 41 (4), 568–575. https://doi.org/10.1016/j.semarthrit.2011.07.002 Additional Declarations No competing interests reported. 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. 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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-4189232","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":286552107,"identity":"d66ab192-0c29-445e-97f1-99fb25be8bf0","order_by":0,"name":"Isabella Amado","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACNjAqsIDweBhsYAxCWgwkYCrTJAhqYUDTcpiwFj7+w88efDCQkGdgP5344U3F+Tr+GQmMD9624bFCIs3ccIaBhGEDT+5myTlnbktI3EhgNpyLVwuDmTSPgQRjA0PuBmnettsSBhIJbEAGHi38x79J/zGQsG/gf7v5N2/bOZAW9t94tTDkmEkDvZ/YIJG7DWj4AbAtzHi1SOSUG/YYSCS3SbzdZjnnTLLkjDMPmyXnnMOtRb7/+LYHPypsbPv5czffeFNhx8/fnnzww5sy3FqQXAgHwKAYBaNgFIyCUUAZAABBxkaj+YGKSQAAAABJRU5ErkJggg==","orcid":"","institution":"Anne Burnett Marion School of Medicine at TCU","correspondingAuthor":true,"prefix":"","firstName":"Isabella","middleName":"","lastName":"Amado","suffix":""},{"id":286552108,"identity":"cde8633a-a4ac-4d1b-b2cc-887314a83773","order_by":1,"name":"Ryan Bialazewski","email":"","orcid":"","institution":"The University of Texas Rio Grande Valley","correspondingAuthor":false,"prefix":"","firstName":"Ryan","middleName":"","lastName":"Bialazewski","suffix":""},{"id":286552109,"identity":"ca8d43b2-376b-48f5-9923-88d30714387b","order_by":2,"name":"Bretton Laboret","email":"","orcid":"","institution":"The University of Texas Southwestern Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Bretton","middleName":"","lastName":"Laboret","suffix":""},{"id":286552110,"identity":"6bc092ca-a07e-4a4f-befd-f892c6c91b6d","order_by":3,"name":"John Gaddis","email":"","orcid":"","institution":"The University of Texas Rio Grande Valley","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Gaddis","suffix":""},{"id":286552111,"identity":"2b9c94fd-5536-48d5-8c29-f32341cd8aae","order_by":4,"name":"Ruthvik Allala","email":"","orcid":"","institution":"Anne Burnett Marion School of Medicine at TCU","correspondingAuthor":false,"prefix":"","firstName":"Ruthvik","middleName":"","lastName":"Allala","suffix":""},{"id":286552112,"identity":"d0d692ca-0936-4eed-8170-401cb82c0740","order_by":5,"name":"Vanessa Lopez","email":"","orcid":"","institution":"The University of Texas Rio Grande Valley","correspondingAuthor":false,"prefix":"","firstName":"Vanessa","middleName":"","lastName":"Lopez","suffix":""},{"id":286552113,"identity":"8d613787-f4ef-4576-b0cf-64d4ca6dcd9c","order_by":6,"name":"Cesar Sevilla","email":"","orcid":"","institution":"The University of Texas Rio Grande Valley","correspondingAuthor":false,"prefix":"","firstName":"Cesar","middleName":"","lastName":"Sevilla","suffix":""},{"id":286552114,"identity":"c2ebde3c-9177-41ec-96fe-a47107f26fef","order_by":7,"name":"Yin Xi","email":"","orcid":"","institution":"The University of Texas Southwestern Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yin","middleName":"","lastName":"Xi","suffix":""},{"id":286552115,"identity":"b971e1fb-7ae5-43c7-88f8-a06a8e16fc12","order_by":8,"name":"Joel Wells","email":"","orcid":"","institution":"Baylor Scott \u0026 White Health","correspondingAuthor":false,"prefix":"","firstName":"Joel","middleName":"","lastName":"Wells","suffix":""}],"badges":[],"createdAt":"2024-03-29 17:44:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4189232/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4189232/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54038637,"identity":"aa9f6bff-8c00-4ea8-9a0f-f59c4a087122","added_by":"auto","created_at":"2024-04-03 17:15:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":99659,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart demonstrating the study population.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4189232/v1/299dbf176d43939b387aeefb.png"},{"id":54038615,"identity":"59252955-f91e-4a2a-8432-33e3ad75f33e","added_by":"auto","created_at":"2024-04-03 17:15:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":201259,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative X-ray showing arthritis severity prior to THA.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4189232/v1/93d71a9beca8923880d9cae9.png"},{"id":99495279,"identity":"1c0d5993-555b-44d4-899c-f77dd2b360f6","added_by":"auto","created_at":"2026-01-05 06:10:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1262131,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4189232/v1/4afab34e-7735-483d-95af-5ec7c5bfb5a3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\"Exploring the Impact of Preoperative Radiographic Arthritis Severity on Total Hip Arthroplasty Outcomes\" Can patients with less radiographic hip disease still do well after a THA?","fulltext":[{"header":"Background","content":"\u003cp\u003eOutcomes following THA can be highly variable and may be influenced by radiographic severity at baseline\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Some studies suggest that the aim of surgery should be to correct radiographic abnormalities, while others argue that improving quality of life measures should be the primary goal\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\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\u003c/sup\u003e. It remains questionable, however, if patients with continued hip pain despite conservative measures and less radiographic severity should undergo THA, and if their outcomes will be equivalent to those with severe radiographic disease.\u003c/p\u003e \u003cp\u003eIn patients with osteoarthritis, the severity of arthritis, as measured by radiographic joint space, can vary at symptom onset. Some patients may experience minimal pain despite severe radiographic arthritis, while others may have severe pain with minimal radiographic findings\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. The relationship between OA severity and symptomatology may be associated with various factors, including weight, age, sex, activity level, and psychological status\u003csup\u003e\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/sup\u003e.\u003c/p\u003e \u003cp\u003eTo address this gap in the literature, this study aims to examine if radiographic severity of arthritis prior to THA impacts post-operative patient-reported hip outcome measures. Radiographic severity will be measured using joint space width and Tonnis Grade. By assessing the impact of radiographic severity on post-operative outcomes, this study seeks to provide valuable insights into the decision-making process for offering THA to patients with varying degrees of radiographic disease severity.\u003c/p\u003e \u003cp\u003eOverall, this study aims to contribute to the existing body of knowledge on THA outcomes and inform clinical practice regarding the selection of patients for surgery based on radiographic severity.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003e This was a retrospective HIPAA-compliant study approved by the institutional review board.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eInclusion criteria for our study included all patients undergoing THA by a single surgeon between 09/01/2016 and 10/31/2021. Eight-hundred and eighty hips met inclusion criteria and were retrospectively reviewed. Exclusion criteria included lack of preoperative or postoperative survey completion, less than a minimum of one-year postoperative follow-up, and lack of pre-operative radiographs. Four hundred and sixty-two hips were analyzed in the study after applying the exclusion criteria (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Demographics collected for our study population include sex, age, height, weight, and body mass index (BMI). Additional factors reported for each hip include surgical approach\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, laterality, length of follow-up, and joint space width.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eImaging Protocol\u003c/h2\u003e \u003cp\u003eImaging was done under standardized protocol. All patients received a standing AP pelvis radiograph and cross table lateral from the same radiographic center.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eImaging Analysis\u003c/h2\u003e \u003cp\u003eThe analysis involved the assessment of joint space width, which was performed by four medical students under the guidance of an experienced orthopedic surgeon. A comprehensive training session was conducted to establish a uniform understanding and interpretation of observation criteria to reduce the potential bias introduced by the researchers. Joint space width was determined by measuring the narrowest section of the joint between the femoral head and acetabulum to the nearest tenth of a millimeter (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Radiographs with loss of joint space secondary to severe arthritis leading to bone-on-bone contact were recorded as having 0 mm of joint space.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eRadiographic Severity Grading\u003c/h2\u003e \u003cp\u003eT\u0026ouml;nnis grading was used to further classify the degree of osteoarthritis. These were all calculated by a single orthopaedic surgeon who has extensive knowledge and expertise in the field\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The T\u0026ouml;nnis grading is a standardized method of classifying OA consisting of three progressive degrees of degenerative changes to the hip\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The score ranges from 0\u0026ndash;3, with 0 indicating hip absence of arthrosis and 3 being the most severe, indicating severe narrowing of the joint space, moderate loss of femoral head sphericity, large cysts and/or avascular necrosis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). No additional studies, such as diagnostic hip injections or other imaging, were used to confirm the diagnosis.\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\u003eT\u0026ouml;nnis grading scale of hip osteoarthritis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRadiographic features\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo signs of osteoarthritis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlight narrowing of joint space\u003c/p\u003e \u003cp\u003eSlight lipping at joint margin\u003c/p\u003e \u003cp\u003eSlight sclerosis of the femoral head or acetabulum\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmall cysts in the femoral head or acetabulum\u003c/p\u003e \u003cp\u003eIncreasing narrowing of joint space\u003c/p\u003e \u003cp\u003eModerate loss of sphericity of the femoral head\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLarge cysts\u003c/p\u003e \u003cp\u003eSevere narrowing or obliteration of joint space\u003c/p\u003e \u003cp\u003eSevere deformity of femoral head\u003c/p\u003e \u003cp\u003eAvascular necrosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatient-Reported Outcomes Measurements (PROM)\u003c/h2\u003e \u003cp\u003ePROMs were evaluated before and after surgery. Pre-operative surveys were administered at the initial visit, while post-operative surveys were given at each follow up visit with intervals on six weeks, six months, one year, two years, and three years. The most recent post-operative surveys were used for each patient, while those with less than one year follow up surveys were excluded from the study. The Harris Hip Score (HHS), Hip Outcome Score (HOS), Short-Form-12 Scale (SF-12) were assessed (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). All outcome measures have been previously validated\u003csup\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,\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,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.\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\u003ePatient-reported outcome measures.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResponse\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarris Hip Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0-100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigher score indicates better health status\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHOS Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0-100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigher score indicates higher function\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShort-Form-12 scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0-100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigher score indicates better health status\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Methods\u003c/h2\u003e \u003cp\u003ePatient demographics for the sample of 462 patients with a range of Tonnis grades (0\u0026ndash;3), diagnoses, preoperative PROMs, postoperative PROMs, and delta change for each PROM were reported using the sample mean and standard deviation for continuous variables and count and percentage for categorical variables.\u003c/p\u003e \u003cp\u003eStatistical analyses were carried out using Statistical Package for the Social Sciences (SPSS) software. The level of significance was set at α\u0026thinsp;=\u0026thinsp;0.05 (two-tailed).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 462 hips were included in this study, with a mean age of 61.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2 years. Of these, 269 (58.2%) were female and 193 (41.8%) were male. The mean BMI was 28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8 kg/m\u003csup\u003e2\u003c/sup\u003e, and the mean follow-up time was 680.2\u0026thinsp;\u0026plusmn;\u0026thinsp;282.7 days. The preoperative radiographic severity scores were graded based on Tonnis grades with 27 hips graded 0, 56 graded 1, 73 graded 2, and 306 graded 3 (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Preoperative diagnoses were assessed, those with a higher Tonnis grade were predominantly diagnosed with OA (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAdditional patient factors compared to Tonnis grade.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTonnis Grade\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0 (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1 (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2 (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3 (n\u0026thinsp;=\u0026thinsp;306)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;462)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAge (yrs.)\u003c/p\u003e\n \u003cp\u003eFemale sex\u003c/p\u003e\n \u003cp\u003eMale sex\u003c/p\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003cp\u003eWeight\u003c/p\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.6\u0026thinsp;\u0026plusmn;\u0026thinsp;17.3\u003c/p\u003e\n \u003cp\u003e13 (48.1%)\u003c/p\u003e\n \u003cp\u003e14 (51.9%)\u003c/p\u003e\n \u003cp\u003e67.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\n \u003cp\u003e164.2\u0026thinsp;\u0026plusmn;\u0026thinsp;37.3\u003c/p\u003e\n \u003cp\u003e25.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.9\u0026thinsp;\u0026plusmn;\u0026thinsp;15.0\u003c/p\u003e\n \u003cp\u003e39 (69.6%)\u003c/p\u003e\n \u003cp\u003e17 (30.4%)\u003c/p\u003e\n \u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\n \u003cp\u003e173.3\u0026thinsp;\u0026plusmn;\u0026thinsp;39.5\u003c/p\u003e\n \u003cp\u003e27.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.2\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e\n \u003cp\u003e44 (60.3%)\u003c/p\u003e\n \u003cp\u003e29 (39.7%)\u003c/p\u003e\n \u003cp\u003e67.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e\n \u003cp\u003e183.7\u0026thinsp;\u0026plusmn;\u0026thinsp;42.0\u003c/p\u003e\n \u003cp\u003e28.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6\u003c/p\u003e\n \u003cp\u003e173 (56.5%)\u003c/p\u003e\n \u003cp\u003e133 (43.5%)\u003c/p\u003e\n \u003cp\u003e67.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e\n \u003cp\u003e187.4\u0026thinsp;\u0026plusmn;\u0026thinsp;45.2\u003c/p\u003e\n \u003cp\u003e29.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e\n \u003cp\u003e269 (58.2%)\u003c/p\u003e\n \u003cp\u003e193(41.8%)\u003c/p\u003e\n \u003cp\u003e67.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\n \u003cp\u003e183.8\u0026thinsp;\u0026plusmn;\u0026thinsp;44.0\u003c/p\u003e\n \u003cp\u003e28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.0010.204\u003c/p\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean follow-up\u003c/strong\u003e (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e636.0\u0026thinsp;\u0026plusmn;\u0026thinsp;226.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e636.2\u0026thinsp;\u0026plusmn;\u0026thinsp;259.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e691.0\u0026thinsp;\u0026plusmn;\u0026thinsp;293.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e689.6\u0026thinsp;\u0026plusmn;\u0026thinsp;288.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e680.2\u0026thinsp;\u0026plusmn;\u0026thinsp;282.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaterality\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRight hips (n)\u003c/p\u003e\n \u003cp\u003eJoint space width (mm)\u003c/p\u003e\n \u003cp\u003eLeft hips (n)\u003c/p\u003e\n \u003cp\u003eJoint space width (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (59.3%)\u003c/p\u003e\n \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n \u003cp\u003e141(40.7%)\u003c/p\u003e\n \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (62.5%)\u003c/p\u003e\n \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n \u003cp\u003e21 (37.5%)\u003c/p\u003e\n \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (52.1%)\u003c/p\u003e\n \u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n \u003cp\u003e35 (47.9%)\u003c/p\u003e\n \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e170 (55.6%)\u003c/p\u003e\n \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n \u003cp\u003e136 (44.4%)\u003c/p\u003e\n \u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e259 (56.1%)\u003c/p\u003e\n \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n \u003cp\u003e203 (43.9%)\u003c/p\u003e\n \u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical approach\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAnterior\u003c/p\u003e\n \u003cp\u003ePosterior\u003c/p\u003e\n \u003cp\u003eComplex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (66.7%)\u003c/p\u003e\n \u003cp\u003e9 (33.3%)\u003c/p\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (55.4%)\u003c/p\u003e\n \u003cp\u003e24 (42.9%)\u003c/p\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (50.7%)\u003c/p\u003e\n \u003cp\u003e30 (41.1%)\u003c/p\u003e\n \u003cp\u003e6 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137 (45.1%)\u003c/p\u003e\n \u003cp\u003e157 (51.6%)\u003c/p\u003e\n \u003cp\u003e10 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e223 (48.5%)\u003c/p\u003e\n \u003cp\u003e220 (47.8%)\u003c/p\u003e\n \u003cp\u003e17 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eHip pathology diagnoses based on Tonnis grade.\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTonnis Grade\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0 (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1 (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2 (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3 (n\u0026thinsp;=\u0026thinsp;306)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;462)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOsteoarthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61 (83.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e241 (78.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e302 (65.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHip Dysplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (69.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOsteonecrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (40.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (14.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerthes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost-traumatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemoral acetabular impingement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInflammatory arthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcetabular protrusio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiple epiphyseal dysplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHip fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNative septic arthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ePatient-reported outcome analysis demonstrates substantial improvement in HHS following THA, irrespective of initial Tonnis grades. HHS mean improvement by order of increasing Tonnis grade was 38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7, 41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6, 46.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4, 45.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8, respectively. Although these findings had a statistically significant difference in mean change of HHS scores, there was no notable difference in post-operative HHS following surgery (p\u0026thinsp;=\u0026thinsp;0.164) (Table 5).\u003c/p\u003e\n\u003cdiv\u003e\u003cbr\u003e\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePreop, Postop, and delta change based on Tonnis grade.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTonnis Grade\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0 (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1 (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2 (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3 (n\u0026thinsp;=\u0026thinsp;306)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;462)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHarris Hip Score\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003cp\u003eNet Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e\n \u003cp\u003e86.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\n \u003cp\u003e38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e\n \u003cp\u003e88.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e\n \u003cp\u003e41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e\n \u003cp\u003e89.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\n \u003cp\u003e45.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e\n \u003cp\u003e88.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e\n \u003cp\u003e46.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\n \u003cp\u003e88.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e\n \u003cp\u003e45.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003cp\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHip Outcome Score\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003cp\u003eNet Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.8\u0026thinsp;\u0026plusmn;\u0026thinsp;26.3\u003c/p\u003e\n \u003cp\u003e49.1\u0026thinsp;\u0026plusmn;\u0026thinsp;27.9\u003c/p\u003e\n \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.7\u0026thinsp;\u0026plusmn;\u0026thinsp;21.6\u003c/p\u003e\n \u003cp\u003e50.1\u0026thinsp;\u0026plusmn;\u0026thinsp;20.8\u003c/p\u003e\n \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1\u003c/p\u003e\n \u003cp\u003e47.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2\u003c/p\u003e\n \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.9\u0026thinsp;\u0026plusmn;\u0026thinsp;21.8\u003c/p\u003e\n \u003cp\u003e41.7\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7\u003c/p\u003e\n \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.2\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2\u003c/p\u003e\n \u003cp\u003e44.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2\u003c/p\u003e\n \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003cp\u003e0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eShort-Form 12\u003c/strong\u003e Preoperative\u003c/p\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003cp\u003eNet Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;32.8\u003c/p\u003e\n \u003cp\u003e43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;27.4\u003c/p\u003e\n \u003cp\u003e16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;48.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.2\u0026thinsp;\u0026plusmn;\u0026thinsp;29.6\u003c/p\u003e\n \u003cp\u003e36.6\u0026thinsp;\u0026plusmn;\u0026thinsp;22.3\u003c/p\u003e\n \u003cp\u003e9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.5\u0026thinsp;\u0026plusmn;\u0026thinsp;33.2\u003c/p\u003e\n \u003cp\u003e39.7\u0026thinsp;\u0026plusmn;\u0026thinsp;22.8\u003c/p\u003e\n \u003cp\u003e6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;43.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;31.2\u003c/p\u003e\n \u003cp\u003e40.8\u0026thinsp;\u0026plusmn;\u0026thinsp;25.1\u003c/p\u003e\n \u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.1\u0026thinsp;\u0026plusmn;\u0026thinsp;31.5\u003c/p\u003e\n \u003cp\u003e40.3\u0026thinsp;\u0026plusmn;\u0026thinsp;24.5\u003c/p\u003e\n \u003cp\u003e12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;45.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.504\u003c/p\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eHOS scores exhibited statistical significance, revealing higher postoperative HOS scores for Tonnis grade 0 (49.1\u0026thinsp;\u0026plusmn;\u0026thinsp;27.9) and grade 1 (50.1\u0026thinsp;\u0026plusmn;\u0026thinsp;20.8) in comparison to Tonnis grades 2 and 3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). However, the mean difference in HOS scores post-operatively failed to attain significance (p\u0026thinsp;=\u0026thinsp;0.447). For SF-12, the mean improvement in order of increasing Tonnis grades was 16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;48.7, 9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;38.3, 6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;43.4, 14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;45.2. Irrespective of baseline Tonnis grade, no significance in pre-operative, post-operative, or mean difference values was observed (0.504, 0.681, and 0.565, respectively).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTotal hip arthroplasty is a widely utilized surgical treatment option for osteoarthritis of the hip, with good long-term outcomes\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\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,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. However, few outcomes have been reported for patients undergoing THA with a lack of, or minimal, preoperative radiographic disease burden\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\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,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Our study is one of the largest databases of patients undergoing THA with minimal disease burden to our knowledge. Therefore, we aimed to define and analyze patient outcomes and compare these patients to those with significant radiographic disease. Our data suggests that patients with hip disease, irrespective of the severity of radiographic grading, can still improve after total hip arthroplasty.\u003c/p\u003e \u003cp\u003eThis study has limitations. First, this retrospective study represents a single surgeon\u0026rsquo;s experience with an emphasis on hip preservation surgery in a high-volume practice. This author (JW) is a technical expert, and as a single-surgeon series, this is a strength and weakness. The results obtained might not accurately reflect the experiences of low-volume practices, thus limiting the generalizability. Future research should consider utilizing larger sample sizes to enhance the applicability of our findings. This would greatly bolster the generalizability of our results, especially for high-volume joint centers where this study could serve as a valuable reference for guiding surgeons. Moreover, it's important to note that our study did not assess or correct intraoperative head and neck offset, nor did it analyze postoperative radiographs for head and neck offset during the initial surgical timeframe. Existing literature has demonstrated the significance of femoroacetabular impingement (FAI) following total hip arthroplasty (THA), which can significantly impact patient outcomes\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Unfortunately, we could not stratify our data to account for FAI-related impairments in this study.\u003c/p\u003e \u003cp\u003eThe relatively short follow-up period for joint arthroplasty should be considered, as longer follow-up periods provide a more comprehensive understanding of the intervention's effects over time. Our study had a mean follow-up time of 680 days, and we do not know if long-term follow-up timeframes will have similar patient outcomes between each group. Addressing these limitations through prospective designs, longer follow-up periods, and larger sample sizes would strengthen the validity of our findings and open avenues for further exploration. Another consideration for future research would be classifying outcomes based on a more sensitive imaging modality, such as magnetic resonance imaging (MRI).\u003c/p\u003e \u003cp\u003eHHS and HOS have historically been the gold standard for quantifying patient outcomes following THA\u003csup\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,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. HHS domains covered are pain, function, absence of deformity, and range of motion, with scores\u0026thinsp;\u0026ge;\u0026thinsp;80 denoted as clinically accurate criteria for determining good patient outcomes\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. HOS contains two domains, activities of daily living (ADL) and sports, that consist of 28 items\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. There is no particular HOS score designating a good outcome; however, higher HOS scores represent a higher level of physical function for both the ADL and sports subscales\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. We have shown that despite not having significant preoperative radiographic disease with preserved joint space, patients have improved HHS and HOS scores following THA. In addition, patients with less severe baseline radiographic findings had similar HHS and higher HOS metrics post-operatively when compared to those with more severe radiographic findings.\u003c/p\u003e \u003cp\u003eOur results include a higher number of hips (83) undergoing primary THA without or with mild preoperative radiographic osteoarthritis (T\u0026ouml;nnis Grade of 0\u0026ndash;1) and directly contradict the findings when compared to the existing literature. Dowsey et al. reported on 382 primary THAs with varying levels of radiographic OA severity (modified Kellgren-Lawrence, mK-L) on the minimum difference (MID, as designated by half the standard deviation of the mean change) in pain and function scores at 1 and 2 years compared to baseline. Their results showed that odds ratios for THAs demonstrating a MID in pain and function scores with less severe baseline radiographic changes were significantly lower at 1 and 2 years than those with severe radiographic changes\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. However, this study is limited by only having 4 patients with a mK-L severity of less than 3 (moderate osteoarthritis). Similarly, Tilbury et al. reported on 302 primary THAs, comparing hip disability and osteoarthritis outcome scores (HOOS) in patients with mild OA (n\u0026thinsp;=\u0026thinsp;78) versus severe OA (n\u0026thinsp;=\u0026thinsp;224) (Kellgren-Lawrence (KL) scores 0\u0026ndash;2 vs. 3\u0026ndash;4)\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Results were notable for lower degrees of change in HOOS for patients with mild OA; however, comparisons were not made on post-operative HOOS scores between the two groups, which is the aim of our study\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Additionally, Valdes et al. examined 928 post-THA patients and stated individuals with lower radiographic severity (n\u0026thinsp;=\u0026thinsp;72) were more likely to experience higher pain postoperatively at a mean of 3.2 years\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Although we did not collect WOMAC pain data in this study, our data contradicts these findings when comparing HHS pain subscales between groups.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study did not find a significant relationship between preoperative radiographic OA severity scores based on T\u0026ouml;nnis grade and outcomes after THA. All patients, regardless of their radiographic severity, improved following THA. This is an important finding, particularly for hips with low radiographic OA severity (T\u0026ouml;nnis grades 0\u0026ndash;1), as it suggests that these patients can achieve favorable outcomes similar to those with higher radiographic disease. PROMs were measured at set intervals, with 208 patients having a greater than 680-days follow-up period. While preoperative radiographic assessment remains crucial in evaluating candidates for THA, it is still important to determine the hip as the culprit of the symptomatology, no matter what stage of radiographic severity. A comprehensive workup for patients with hip disease should focus less on radiographic imaging findings and more on the patient\u0026rsquo;s history, physical examination findings, and co-morbidities when determining surgical candidacy. Future work may include the long-term outcomes for THA in patients with low radiographic OA severity and better stratification of radiographic OA severity with the use of MRI.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTHA:\u0026nbsp;total hip arthroplasty\u003c/p\u003e\n\u003cp\u003ePROMs: patient reported outcome measures\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHHS: Harris Hip Score\u003c/p\u003e\n\u003cp\u003eHOS: Outcome Score\u003c/p\u003e\n\u003cp\u003eSF-12: Short-Form-12 Scale\u003c/p\u003e\n\u003cp\u003eOA: osteoarthritis\u003c/p\u003e\n\u003cp\u003eBMI: body mass index\u003c/p\u003e\n\u003cp\u003eSPSS: statistical package for the social sciences\u003c/p\u003e\n\u003cp\u003eFAI: femoroacetabular impingement\u003c/p\u003e\n\u003cp\u003eMRI: magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eADL: activities of daily living\u003c/p\u003e\n\u003cp\u003eMID: minimum difference\u003c/p\u003e\n\u003cp\u003emK-L: modified Kellgren-Lawrence\u003c/p\u003e\n\u003cp\u003eKL: Kellgren-Lawrence\u003c/p\u003e\n\u003cp\u003eWOMAC: Western Ontario and McMaster Universities Arthritis Index\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eConflict of Interest Statement: The authors received no financial or material support for the research, authorship, and/or publication of this article.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHIPAA-compliant study approved by the institutional review board (IRB). Informed consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003eUniversity of Texas Southwestern Medical Center IRB number: STU 122016-058.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Informed consent was obtained from all subjects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial or material support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIA: Data curation, methodology, formal analysis, project administration, visualization, writing - original draft, review \u0026amp; editing,\u003c/p\u003e\n\u003cp\u003eRB: Visualization, writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eBL: Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eJG: Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eRA: Data curation, writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eVL: Data curation, writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eCS: Data curation, writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eYX: Data curation, statistical analysis\u003c/p\u003e\n\u003cp\u003eJW: Supervision, conceptualization, methodology, project administration, resources, validation, writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStambough, J. 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Are Complications After the Bernese Periacetabular Osteotomy Associated With Subsequent Outcomes Scores?. \u003cem\u003eClinical orthopaedics and related research\u003c/em\u003e, \u003cem\u003e477\u003c/em\u003e(5), 1157\u0026ndash;1163. https://doi.org/10.1097/CORR.0000000000000566\u003c/li\u003e\n\u003cli\u003eKovalenko, B., Bremjit, P., \u0026amp; Fernando, N. (2018). Classifications in Brief: T\u0026ouml;nnis Classification of Hip Osteoarthritis. \u003cem\u003eClinical orthopaedics and related research\u003c/em\u003e, \u003cem\u003e476\u003c/em\u003e(8), 1680\u0026ndash;1684. https://doi.org/10.1097/01.blo.0000534679.75870.5f\u003c/li\u003e\n\u003cli\u003eNilsdotter, A., \u0026amp; Bremander, A. (2011). 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(2008). Outcome measures for orthopaedic interventions on the hip. The Journal of bone and joint surgery. British volume, 90(5), 545\u0026ndash;549. https://doi.org/10.1302/0301-620X.90B5.19746\u003c/li\u003e\n\u003cli\u003eS\u0026ouml;derman, P., \u0026amp; Malchau, H. (2001). Is the Harris hip score system useful to study the outcome of total hip replacement?. Clinical orthopaedics and related research, (384), 189\u0026ndash;197. https://doi.org/10.1097/00003086-200103000-00022\u003c/li\u003e\n\u003cli\u003eNilsdotter, A. K., Lohmander, L. S., Kl\u0026auml;ssbo, M., \u0026amp; Roos, E. M. (2003). Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement. BMC musculoskeletal disorders, 4, 10. https://doi.org/10.1186/1471-2474-4-10\u003c/li\u003e\n\u003cli\u003eMartin, R. L., Kelly, B. T., \u0026amp; Philippon, M. J. (2006). Evidence of validity for the hip outcome score. Arthroscopy : the journal of arthroscopic \u0026amp; related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 22(12), 1304\u0026ndash;1311. https://doi.org/10.1016/j.arthro.2006.07.027\u003c/li\u003e\n\u003cli\u003eStasi, S., Stamou, M., Papathanasiou, G., Frantzeskaki, P., Kanavas, E., Evaggelou-Sossidis, G., Gouskos, A., Palantzas, A., Poursanidis, K., \u0026amp; Macheras, G. A. (2020). International Hip Outcome Tool (12-items) as health-related quality-of-life measure in osteoarthritis: validation of Greek version. Journal of patient-reported outcomes, 4(1), 41. https://doi.org/10.1186/s41687-020-00207-8\u003c/li\u003e\n\u003cli\u003eM\u0026oslash;rup-Petersen, A., Skou, S. T., Holm, C. E., Holm, P. M., Varnum, C., Krogsgaard, M. R., Laursen, M., \u0026amp; Odgaard, A. (2021). 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Radiographic stage of osteoarthritis or sex of the patient does not predict one year outcome after total hip arthroplasty. Ann Rheum Dis. 2001;60(3):228.\u003c/li\u003e\n\u003cli\u003eBabiak-Vazquez AE, Cruz-Martinez R, Garza-Elizondo MA, Davila-Perez R, Davila-Gonzalez EO, Pena-Martinez VM, Martinez-Gaytan V. (2020). Correlation of radiographic severity and clinical outcomes in patients with knee osteoarthritis. Acta ortopedica mexicana, 34(3), 121-125.\u003c/li\u003e\n\u003cli\u003eVan Meirhaeghe, J. P., Alarkawi, D., Kowalik, T., Du-Moulin, W., Molnar, R., \u0026amp; Adie, S. (2021). Predicting dissatisfaction following total hip arthroplasty using a Bayesian model averaging approach: Results from the Australian Arthroplasty Clinical Outcomes Registry National (ACORN). \u003cem\u003eANZ journal of surgery\u003c/em\u003e, \u003cem\u003e91\u003c/em\u003e(9), 1908\u0026ndash;1913. https://doi.org/10.1111/ans.17063\u003c/li\u003e\n\u003cli\u003eKim C, Nevitt MC, Niu J, Clancy MM, Lane NE, Link TM, Vlad S, Tolstykh I, Jungmann PM, Felson DT, Guermazi A. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. \u003cem\u003eBmj\u003c/em\u003e. 2015 Dec 2;351.\u003c/li\u003e\n\u003cli\u003eDowsey MM, Nikpour M, Dieppe P, Choong PFM. Associations between pre-operative radiographic osteoarthritis severity and pain and function after total hip replacement. Clin Rheumatol. 2016;35(1):183\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eChu Miow Lin, D., Reichmann, W. M., Gossec, L., Losina, E., Conaghan, P. G., \u0026amp; Maillefert, J. F. (2011). Validity and responsiveness of radiographic joint space width metric measurement in hip osteoarthritis: a systematic review. \u003cem\u003eOsteoarthritis and cartilage\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(5), 543\u0026ndash;549. https://doi.org/10.1016/j.joca.2010.12.014\u003c/li\u003e\n\u003cli\u003eNilsdotter, A. K., Aurell, Y., Si\u0026ouml;steen, A. K., Lohmander, L. S., \u0026amp; Roos, H. P. (2001). Radiographic stage of osteoarthritis or sex of the patient does not predict one year outcome after total hip arthroplasty. \u003cem\u003eAnnals of the rheumatic diseases\u003c/em\u003e, \u003cem\u003e60\u003c/em\u003e(3), 228\u0026ndash;232. https://doi.org/10.1136/ard.60.3.228\u003c/li\u003e\n\u003cli\u003eVahedi, H., Yacovelli, S., Diaz, C., \u0026amp; Parvizi, J. (2021). Surgical Treatment of Femoroacetabular Impingement: Minimum 10-Year Outcome and Risk Factors for Failure. \u003cem\u003eJB \u0026amp; JS open access\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(4), e20.00176. https://doi.org/10.2106/JBJS.OA.20.00176\u003c/li\u003e\n\u003cli\u003eTilbury, C., Holtslag, M. J., Tordoir, R. L., Leichtenberg, C. S., Verdegaal, S. H., Kroon, H. M., Fiocco, M., Nelissen, R. G., \u0026amp; Vliet Vlieland, T. P. (2016). Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis. A prospective cohort study of 573 patients. \u003cem\u003eActa orthopaedica\u003c/em\u003e, \u003cem\u003e87\u003c/em\u003e(1), 67\u0026ndash;71. https://doi.org/10.3109/17453674.2015.1092369\u003c/li\u003e\n\u003cli\u003eValdes, A. M., Doherty, S. A., Zhang, W., Muir, K. R., Maciewicz, R. A., \u0026amp; Doherty, M. (2012). Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty. \u003cem\u003eSeminars in arthritis and rheumatism\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(4), 568\u0026ndash;575. https://doi.org/10.1016/j.semarthrit.2011.07.002\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"Total hip arthroplasty, arthritis, THA, PROMs","lastPublishedDoi":"10.21203/rs.3.rs-4189232/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4189232/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAs total hip arthroplasty (THA) indications continue to expand and longevity increases, it is important to understand the outcomes in different patient populations. Younger, more active patients are electing to proceed with THA with differing severity of disease. We aimed to investigate patient reported outcome measures (PROMs) in patients who underwent THA with less severe radiographic hip arthrosis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePre- and post-operative PROMs and radiographic data (joint-space width, Tonnis grade) for patients undergoing THA between 9/16/2016 and 10/21/2021 by a single surgeon were collected. Baseline Tonnis grades were stratified, and PROMs, including Harris Hip Score (HHS), Hip Outcome Score (HOS), and Short-Form-12 Scale (SF-12), were compared pre- and post-operatively.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFour-hundred and sixty-two hips underwent analysis. Pre-operative HHS following THA were ​​46.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9, 47.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4, 44.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6, and 42.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7 for Tonnis grades 0 (n\u0026thinsp;=\u0026thinsp;27), 1 (n\u0026thinsp;=\u0026thinsp;56), 2 (n\u0026thinsp;=\u0026thinsp;73), and 3 (n\u0026thinsp;=\u0026thinsp;306), respectively; while post-operative HHS were 86.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8, 88.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7, 89.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4, and 88.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4 Higher postoperative HOS scores were seen in Tonnis grade 0 and 1, when compared to Tonnis grades 2, and 3 (49.1\u0026thinsp;\u0026plusmn;\u0026thinsp;27.9, and 50.1\u0026thinsp;\u0026plusmn;\u0026thinsp;20.8 vs. 47.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2, and 44.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2, respectively; p\u0026thinsp;=\u0026thinsp;0.003), however, no statistical difference was seen in mean difference HOS (p\u0026thinsp;=\u0026thinsp;0.447). For SF-12, the mean improvement in order of increasing Tonnis grades was 16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;48.7, 9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;38.3, 6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;43.4, and 14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;45.2 with no statistical significance observed (p\u0026thinsp;=\u0026thinsp;0.565).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn patients undergoing THA, post-operative HHS scores are similar regardless of baseline radiographic severity. Post-operative change in HOS and SF-12 scales was consistently higher across all baseline Tonnis grades prior to THA, while mean change remained comparable. These findings suggest although preoperative radiographic data aids in the evaluation of patients with hip pain, the severity of findings should not determine surgical candidacy. This study challenges radiographic severity for THA eligibility and adds to THA literature for those with less severe radiographic findings.\u003c/p\u003e","manuscriptTitle":"\"Exploring the Impact of Preoperative Radiographic Arthritis Severity on Total Hip Arthroplasty Outcomes\" Can patients with less radiographic hip disease still do well after a THA?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-03 17:15:31","doi":"10.21203/rs.3.rs-4189232/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":"abcb837e-e6e6-4051-9126-64fda706809e","owner":[],"postedDate":"April 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T06:10:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-03 17:15:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4189232","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4189232","identity":"rs-4189232","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}