Radiological pattern of hip osteoarthritis is associated with one-year patient-reported outcomes but not long-term mortality or revision after total hip arthroplasty

Aims This study aimed to determine the effect of the radiological patterns of hip osteoarthritis (OA) on patient-reported outcome measures (PROMs) at one year following total hip arthroplasty (THA) and their impact on long-term mortality and survivorship. Methods This retrospective study assessed the outcomes of 445 patients with primary hip OA undergoing THA. Plain radiographs were assessed to determine the Kellgren–Lawrence grading, the radiological pattern of arthritis (hypertrophic, atrophic, or mixed) and the predominant location of wear. PROMs assessed included the EQ-5D-3L and Oxford Hip Score (OHS) preoperatively and at 12 months postoperatively. The minimum follow-up for surviving patients was 14.7 years. Across the cohort, including patients who died during follow-up, the mean follow-up was 12.3 years (1.0 to 15.6), with patients censored at death. Multivariable linear regression models were used to evaluate independent predictors of postoperative PROM scores, mortality, and revision. Results In all, 284 females (63.5%) and 161 males (36.5%) were included. Females were more likely to have atrophic OA (n = 120; (42.3%) vs n = 47; (29.2%); p < 0.001). Males were more likely to have hypertrophic OA (n = 52; (32.3%) vs n = 47; (16.5%); p < 0.001). One-year PROM improvement differed by OA pattern: hypertrophic OA had the greatest mean improvement in OHS (+22.6 (SD 7.4)) and EQ-5D-3L (+0.45 (SD 0.32)), compared with mixed (+18.6 (SD 9.5), +0.35 (SD 0.32)) and atrophic OA (+17.3 (SD 11.3), +0.33 (SD 0.32)) OHS (p < 0.001) and EQ-5D-3L (p = 0.005). After adjustment for covariates, atrophic OA remained independently associated with lower postoperative OHS and EQ-5D-3L scores compared with hypertrophic OA. Mortality and revision rates did not differ between OA pattern groups. Conclusion Radiological pattern of hip OA was associated with differences in one-year PROMs following THA. Patients with atrophic OA had smaller improvements following surgery compared with counterparts with hypertrophic OA. No differences were observed in long-term mortality or revision. Radiological pattern may represent a clinically relevant marker of postoperative functional improvement. Cite this article: Bone Jt Open 2026;7(9):1226–1238.