Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2023; 14(12): 853-867
Published online Dec 18, 2023. doi: 10.5312/wjo.v14.i12.853
Comparison of clinical outcomes between total hip replacement and total knee replacement
Alexander Green, Alex Walsh, Oday Al-Dadah
Alexander Green, Alex Walsh, Oday Al-Dadah, Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside NE34 0PL, United Kingdom
Oday Al-Dadah, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4HH, United Kingdom
Author contributions: Green A, Walsh A, and Al-Dadah O contributed to the conception of the study design, data collection and analysis, and all have proofread the manuscript in its final form.
Institutional review board statement: This was a prospective longitudinal observational study which did not require IRB/ethics committee approval but was registered with the local hospital trust.
Informed consent statement: This study was an observational study using existing data from routine clinical care. Therefore, separate consent forms were not required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at alexander.green7@nhs.net.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alexander Green, MBBS, Doctor, Research Fellow, Surgeon, Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside NE34 0PL, United Kingdom. alexander.green7@nhs.net
Received: October 3, 2023
Peer-review started: October 3, 2023
First decision: October 9, 2023
Revised: October 18, 2023
Accepted: November 13, 2023
Article in press: November 13, 2023
Published online: December 18, 2023
Abstract
BACKGROUND

Total hip replacements (THR) and total knee replacements (TKR) are effective treatments for severe osteoarthritis (OA). Some studies suggest clinical outcomes following THR are superior to TKR, the reason for which remains unknown. This study compares clinical outcomes between THR and TKR.

AIM

To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures (PROMs).

METHODS

A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre- and post-operatively.

RESULTS

A total of 131 patients were included in the study which comprised the THR group (68 patients) and the TKR group (63 patients). Both groups demonstrated significant post-operative improvements in all PROM scores (P < 0.001). There were no significant differences in post-operative PROM scores between the two groups: Hip and Knee Osteoarthritis Outcome scores (P = 0.140), Western Ontario and McMaster Universities Osteoarthritis Index pain (P = 0.297) stiffness (P = 0.309) and function (P = 0.945), Oxford Hip and Knee Score (P = 0.076), EuroQol-5D index (P = 0.386) and Short-Form 12-item survey physical component score (P = 0.106). Subgroup analyses showed no significant difference (P > 0.05) between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference (P > 0.05) between cemented and uncemented fixation in the THR group. Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.

CONCLUSION

Contrary to some literature, THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs. The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome. Obesity had a greater influence on the outcome following TKR than that of THR.

Keywords: Obesity, Osteoarthritis, Patient reported outcome measures, Total hip arthroplasty, Total knee arthroplasty

Core Tip: Previous literature has suggested that the when comparing outcomes of total hip and knee replacements, on symptoms, function, and quality of life, as assessed by patient reported outcome measure (PROM) scores, total hip replacement have superior benefits to total knee replacements. This study has demonstrated, when a comprehensive range of PROM scores are used, both procedures are equivocally and very effective for the treatment of severe osteoarthritis. Sub-analysis in the study has confirmed that whilst obese patients have poorer outcomes, they can still greatly benefit from surgical intervention.