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Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis
Thomas Frydendal1, Robin Christensen1, Inger Mechlenburg1
1From the Departments of Physiotherapy (T.F., K.G.I.) and Orthopedic Surgery (C.V., A.E.G., P.K.-A., P.H.R., C.H.), Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle Hospital, Vejle, the Departments of Clinical Research (T.F., R.C., S.M.N.) and Regional Health Research (C.V., K.G.I.), University of Southern Denmark, and the Research Unit of Rheumatology, Department of Clinical Research (R.C., S.M.N.), and the Department of Orthopedic Surgery and Traumatology (S.O.), Odense University Hospital, Odense, the Section for Biostatistics and Evidence-based Research, Parker Institute, Bispebjerg and Frederiksberg Hospital (T.F., R.C., S.M.N., K.G.I.), the Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg (S.O.), and the Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen (S.O.), Copenhagen, the Department of Orthopedic Surgery, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University, Aarhus (I.M., S.S.J.), the University Clinic for Orthopedic Pathways, Elective Surgery Center, Regional Hospital Silkeborg, Silkeborg (L.R.M.), and the Department of Orthopedic Surgery, Næstved Hospital, Næstved (M.J.B., H.Q., M.S.M.) - all in Denmark.
Background:
Total hip replacement is routinely recommended for severe hip osteoarthritis, but data from randomized trials are lacking regarding comparison of the effectiveness of this procedure with that of nonsurgical treatment such as resistance training.
Methods:
We conducted a multicenter, randomized, controlled trial to compare total hip replacement with resistance training in patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery. The primary outcome was the change in patient-reported hip pain and function from baseline to 6 months after the initiation of treatment, assessed with the use of the Oxford Hip Score (range, 0 to 48, with higher scores indicating less pain and better function). Safety was also assessed.
Results:
A total of 109 patients (mean age, 67.6 years) were randomly assigned to total hip replacement (53 patients) or resistance training (56 patients). In an intention-to-treat analysis, the mean increase (indicating improvement) in the Oxford Hip Score was 15.9 points in patients assigned to total hip replacement and 4.5 points in patients assigned to resistance training (difference, 11.4 points; 95% confidence interval, 8.9 to 14.0; P<0.001). At 6 months, 5 patients (9%) who had been assigned to total hip replacement had not undergone surgery, and 12 patients (21%) who had been assigned to resistance training had undergone total hip replacement. The incidence of serious adverse events at 6 months was similar in the two groups; the majority of such events were known complications of total hip replacement.
Conclusions:
In patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery, total hip replacement resulted in a clinically important, superior reduction in hip pain and improved hip function, as reported by patients, at 6 months as compared with resistance training. (Funded by the Danish Rheumatism Association and others; PROHIP ClinicalTrials.gov number, NCT04070027.).
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