Moderate hip arthritis is linked to half the odds of a meaningful gain from replacement

The edition in brief

A meta-analysis of 18 observational studies (9,235 patients) compared outcomes after primary total hip arthroplasty in moderate versus severe radiographic osteoarthritis. Pain relief at about a year did not differ, but function and quality of life were modestly better with severe disease, and in adjusted analyses patients with moderate disease had 49% lower odds of a clinically meaningful response (OR 0.51, 0.36–0.72); heterogeneity was high. A three-centre Chinese trial of 240 patients with Kellgren-Lawrence grade I–II knee osteoarthritis found a standardised PRP pathway — patient selection, leukocyte-poor PRP, ultrasound guidance, staged rehabilitation and follow-up — gave better 12-month pain and function than physician-directed PRP, with fewer adverse events; it had no placebo arm and does not show PRP itself works. A Scottish series of 205 patients with metastatic disease of the proximal femur treated with a long modular uncemented stem found a two- and five-year probability of reintervention for femoral failure of about 1%, with death as a competing risk; 68% died during follow-up. The pearl is about finding the real source of hip-region pain before listing.