Background & Aims

Detecting predictors influencing the choice between surgical intervention and conservative treatment in hip osteoarthritis is crucial. Unraveling these factors is vital for tailored patient care. This prospective cohort study aimed to investigate the influence of pain, psychosocial and psychophysical features, and hip disability factors on patients’ decision to undergo hip replacement surgery for unilateral hip osteoarthritis.

Methods

Subjects aging over 18 with unilateral painful hip osteoarthritis were selected through medical history, clinical examination, and hip X-ray imaging. Pain, hip disability, psychosocial, and psychophysical parameters, were assessed using Visual Analogic Scale (VAS), Harris Hip Score (HHS), Pain Catastrophizing Scale (PCS), Pressure Pain Threshold (PPT), and Conditioned Pain Modulation (CPM). Patients were evaluated at inclusion and after a one-month conservative treatment which comprised medications, exercises, and physiotherapy. Patients were asked about their satisfaction with conservative treatment, and dissatisfied individuals were offered the option of hip surgery. Based on their decision, patients were categorized into Non-Surgical and Surgical groups for statistical analysis. T-tests, chi-squared tests, and two-way repeated measures ANOVA compared groups. Binomial logistic regression analyzed the probability of opting for surgical treatment.

Results

Fifty-one subjects with unilateral hip osteoarthritis were evaluated. No dropouts occurred. Significant differences were observed between surgical and non-surgical groups for coxarthrosis degree, pain duration, PCS, and HHS (p<0.05). Patients opting for surgery had higher pain, psychosocial and hip impairment. The logistic regression model explained 59.1% of variance and identified HHS and higher pain levels during Flexion, Adduction, Internal Rotation (FADIR) test as significant predictors for the decision to undergo surgery. Specifically, an increase in FADIR pain levels is correlated with a heightened probability of opting for hip surgery.

Conclusions

In conclusion, this study offers valuable insights into the multifaceted factors influencing patients’ choices for hip replacement surgery. Emphasizing the importance of a comprehensive assessment, including psychosocial evaluation, is pivotal. Furthermore, our findings underscore the significance of pain levels during passive movements and the degree of joint disability as critical influencers in the decision-making process regarding surgical intervention. These considerations contribute significantly to the overall understanding of factors guiding clinical decisions and ultimately improving patient care in hip osteoarthritis management.

References

1. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet 2019; 393: 1745–1759.
2. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014; 73: 1323–1330.
3. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil 2019; 27: 1578–1589.
4. Gademan MGJ, Hofstede SN, Vliet Vlieland TPM, et al. Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskelet Disord 2016; 17: 1–11.
5. Postler A, Goronzy J, Günther KP, et al. Which disease-related factors influence patients’ and physicians’ willingness to consider joint replacement in hip and knee OA? Results of a questionnaire survey linked to claims data. BMC Musculoskelet Disord 2020; 21: 1–11.

Presenting Author

Matheus Herreira-Ferreira

Poster Authors

Matheus Herreira-Ferreira

DDS, MSc

University of São Paulo

Lead Author

Rafaela Salbego DDS

MSc

University of São Paulo

Lead Author

Beatriz Lima-Netto; DDS

Master's Degree student

University of São Paulo

Lead Author

Sérgio de Paula MD

MSc

University of São Paulo

Lead Author

Yuri M. Costa. DDS

Ph.D

University of Campinas

Lead Author

Paulo Conti

University of São Paulo

Lead Author

Leonardo Bonjardim

University of São Paulo

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Rheumatology, Arthritis, and Other