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Comparative Study
. 2025 Apr 14:96:310-316.
doi: 10.2340/17453674.2025.43332.

Effectiveness of total hip arthroplasty versus non-surgery on patient-reported hip function at 3 months: a target trial emulation study of patients with osteoarthritis

Amanda D Klaassen  1 , Wiard Jorritsma  2 , Nienke W Willigenburg  3 , Carina L E Gerritsma  4 , Bas L E F Ten Have  4 , Dirk Jan F Moojen  3 , Maaike G J Gademan  5 , Rolf H H Groenwold  6 , Rudolf W Poolman  7
Affiliations
Comparative Study

Effectiveness of total hip arthroplasty versus non-surgery on patient-reported hip function at 3 months: a target trial emulation study of patients with osteoarthritis

Amanda D Klaassen et al. Acta Orthop. .

Abstract

Background and purpose: This study introduces an innovative research design in the field of orthopedics, using a target trial emulation approach. We aimed to assess the causal effects of total hip arthroplasty (THA) compared with nonoperative treatment in reducing patient-reported hip disability at 3 months in patients with osteoarthritis, using real-world data.

Methods: We emulated a target trial using real-world data of 2 Dutch hospitals between April 2020 and January 2022. Patients diagnosed with hip osteoarthritis and eligible for primary THA were included in the study. During the COVID-19 pandemic, THA was often cancelled due to external factors (i.e., limited operating room capacity, or surgeon unavailable due to quarantine rules), resulting in an arbitrary allocation of patients to THA (n = 132) or non-THA (n = 60). We compared changes in hip disability, measured using the Hip disability and Osteoarthritis Outcome Score Physical function Short form (HOOS-PS), between the THA group at 3 months postoperatively and the non-THA group at ≥3 months post waiting-list. Linear regression analysis, adjusting for potential confounders, was used to compare between-group differences.

Results: THA showed preferable outcomes compared with non-THA, indicated by a difference of -33 points (95% confidence interval [CI] -37 to -28) on the HOOS-PS. Patients in the THA group demonstrated a clinically significant improvement in hip function, with a mean change of -27 points (CI -31 to -24), while the control group showed no improvement with a mean change of 7 points (CI 3-11) on the HOOS-PS.

Conclusion: THA significantly improves hip function in osteoarthritis patients, surpassing the outcomes observed in the non-surgery group.

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Figures

Figure 1
Figure 1
Patient flow chart. THA = total hiparthroplasty.
Figure 2
Figure 2
Follow-up time (number of days between intake and follow-up questionnaire) for individual patients in the 2 groups.
See this image and copyright information in PMC

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References

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