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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Musculoskeletal Disorders 1/2016

Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review

BMC Musculoskeletal Disorders > Ausgabe 1/2016
Stefanie N. Hofstede, Maaike G. J. Gademan, Thea P. M. Vliet Vlieland, Rob G. H. H. Nelissen, Perla J. Marang-van de Mheen
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12891-016-1070-3) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

SH and MG selected articles. SH extracted the data and MG checked the extracted data. Risk of bias for each article was assessed by SH, checked by MG and in case of not reaching consensus by PM. SH wrote the article. PM supervised writing of the manuscript. MG, PM, TV, and RN have critically read and modified the manuscript, and have approved the final version.



This systematic review examines which patient related factors influence functional and clinical outcomes after total hip arthroplasty (THA) in patients with hip osteoarthritis (OA).


We performed a systematic review according to the PRISMA guidelines. We searched databases and trial registries for prospective studies including OA patients who underwent primary THA. Studies with preoperative measurements on predictors, with at least 1 year follow-up were included. Risk of bias and confounding was assessed for two domains: follow-up rate and looking at independent effects.


Thirty-five studies were included (138,039 patients). Only nine studies (29 %) had low risk of bias for all domains thus suggesting an overall low quality of evidence. Studies were heterogeneous in the predictors tested and in the observed directions of the associations. Overall, preoperative function (13 studies (37 %), 2 with low risk of bias) and radiological OA (6 studies (17 %), 1 with low risk of bias) were predictors with the most consistent findings. Worse preoperative function and more severe radiological OA were associated with larger postoperative improvement. However, these patients never reached the level of postoperative functioning as patients with better preoperative function or less severe radiological OA. For age, gender, comorbidity, pain and quality of life the results of studies were conflicting. For BMI, some studies (n = 5, 2 with low risk of bias) found worse outcomes for patients with higher BMI. However, substantial improvement was still achieved regardless of their BMI.


There is not enough evidence to draw succinct conclusions on preoperative predictors for postoperative outcome in THA, as results of studies are conflicting and the methodological quality is low. Results suggest to focus on preoperative function and radiological osteoarthritis to decide when THA will be most effective. The present mapping of current evidence on the relationship between patient related factors and outcomes provides better information compared to individual studies and may help to set patient expectations before surgery. In addition, these findings may contribute to discussions on how to achieve the best possible postoperative outcome for specific patient groups.

Trial registration

This systematic review was registered in Prospero, registration number RD42014009977.
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