Clark Sean C, Rudisill Samuel S, Reuter Zachary C, Couch Cory G, Taunton Michael J, Hevesi Mario
From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Am Acad Orthop Surg. 2025 Jun 15;33(12):637-643. doi: 10.5435/JAAOS-D-24-00656. Epub 2024 Oct 1.
It is currently unclear whether patients with rheumatoid arthritis have similar functional outcomes after total hip arthroplasty (THA) as those with osteoarthritis, particularly given that rheumatoid arthritis may have systemic manifestations in terms of pain and function. The purpose of this study was to compare patient-reported outcome measures between patients with rheumatoid arthritis and matched control patients with osteoarthritis who underwent direct anterior THA.
All patients who underwent direct anterior THA from 2010 to 2022 at a single academic institution were retrospectively reviewed. Hips with rheumatoid arthritis were propensity matched to hips with osteoarthritis on a 1:4 basis. Patient-reported outcome measures, including visual analog scale (VAS) pain at rest and with use, Hip Disability and Osteoarthritis Outcome Score Pain, and Forgotten Joint Score-12, were obtained at follow-up. In addition, modified Harris Hip Scores (mHHS) were obtained both preoperatively and at the final follow-up.
Forty-six hips with rheumatoid arthritis and 184 hips with osteoarthritis were followed for a mean of 6.3 ± 3.6 years. Both cohorts demonstrated notable preoperative to postoperative improvements in mHHS ( P < 0.001). No differences were observed at the final follow-up between cohorts for VAS at rest (0.8 vs. 0.5, P = 0.333), VAS with use (1.3 vs. 0.9, P = 0.234), Hip Disability and Osteoarthritis Outcome Score Pain (90.4 vs. 93.6, P = 0.113), Forgotten Joint Score-12 (80.3 vs. 82.8, P = 0.529), and mHHS (86.9 vs. 89.0, P = 0.335). One patient with rheumatoid arthritis had an intraoperative periprosthetic calcar fracture, whereas none underwent subsequent revision THA.
Patients with rheumatoid arthritis and osteoarthritis who underwent direct anterior THA achieved comparable outcomes in this propensity-matched analysis. Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary THA.
目前尚不清楚类风湿性关节炎患者在全髋关节置换术（THA）后的功能结局是否与骨关节炎患者相似，尤其是考虑到类风湿性关节炎在疼痛和功能方面可能有全身表现。本研究的目的是比较类风湿性关节炎患者与接受直接前路THA的匹配骨关节炎对照患者的患者报告结局指标。
对2010年至2022年在单一学术机构接受直接前路THA的所有患者进行回顾性研究。类风湿性关节炎的髋关节与骨关节炎的髋关节按1:4的比例进行倾向匹配。在随访时获得患者报告的结局指标，包括静息和使用时的视觉模拟量表（VAS）疼痛、髋关节残疾和骨关节炎结局评分疼痛以及遗忘关节评分-12。此外，术前和最终随访时均获得改良Harris髋关节评分（mHHS）。
46例类风湿性关节炎髋关节和184例骨关节炎髋关节平均随访6.3±3.6年。两个队列在术前至术后mHHS均有显著改善（P<0.001）。在最终随访时，两个队列在静息VAS（0.8对0.5，P=0.333）、使用VAS（1.3对0.9，P=0.234）、髋关节残疾和骨关节炎结局评分疼痛（90.4对93.6，P=0.113）、遗忘关节评分-12（80.3对82.8，P=0.529）和mHHS（86.9对89.0，P=0.335）方面均未观察到差异。1例类风湿性关节炎患者术中发生假体周围股骨距骨折，而无一例接受后续翻修THA。
在这项倾向匹配分析中，接受直接前路THA 的类风湿性关节炎患者和骨关节炎患者取得了可比的结局。虽然类风湿性关节炎患者可能有更高的并发症和翻修手术风险，但患者在初次THA后可预期疼痛减轻和功能结局改善，与骨关节炎患者相似。
