Association between preoperative radiographic osteoarthritis severity and patient-reported outcomes after total hip arthroplasty: a systematic review and meta-analysis.

PURPOSE: Although total hip arthroplasty (THA) reliably improves pain and function in patients with hip osteoarthritis (OA), a subset of patients experience limited postoperative benefit. The association between preoperative radiographic OA severity and postoperative patient-reported outcomes (PROMs) remains controversial.

METHODS

We performed a systematic review and meta-analysis according to PRISMA guidelines. Electronic databases (MEDLINE, Embase, and Cochrane Library) were searched for studies comparing postoperative PROMs after primary THA between patients with moderate versus severe radiographic OA. The primary outcome was postoperative PROMs at approximately 12 ± six months. Random-effects meta-analyses were conducted using standardized mean differences (SMDs). Adjusted continuous and responder outcomes, complications, and sensitivity analyses were also evaluated.

RESULTS

Eighteen observational studies (9,235 patients) were included. Severe radiographic OA showed statistically significant but modest advantages in function (SMD - 0.34; 95% CI - 0.62 to - 0.07; I2 = 83%) and health-related quality of life (HRQoL; SMD - 0.33; 95% CI - 0.54 to - 0.11; I2 = 70%), while pain did not differ (SMD - 0.14; 95% CI - 0.51 to 0.22; I2 = 79%). Substantial heterogeneity limits confidence in these estimates. Adjusted analyses showed a mean difference of - 4.0 points on function scales and 49% lower odds of a clinically meaningful response in the moderate group (OR 0.51; 95% CI 0.36-0.72). No statistically detectable differences in complication rates were observed.

CONCLUSION

Greater preoperative radiographic OA severity was associated with statistically significant but modest advantages in postoperative function and HRQoL, whereas pain relief was comparable across severity groups. Although patients with moderate OA may experience symptomatic improvement, their likelihood of achieving a clinically meaningful response appears lower. These findings support careful patient selection, realistic expectation-setting, and thorough evaluation of pain sources before proceeding to THA.