medwireNews: A study published in The New England Journal of Medicine suggests that total hip replacement (THR) for severe hip osteoarthritis significantly improves pain and function in adults aged 50 years or older compared with resistance training.
The multicenter trial by Thomas Frydendal, from Vejle Hospital in Denmark, and colleagues, enrolled 109 adults (mean age 67.6 years) who had severe hip osteoarthritis (median duration of symptoms 1.7 years) and were candidates for surgery, based on hip pain, clinical presentation, and radiography. Key exclusion criteria included severe walking deficits (reliance on two crutches or a walker), a BMI over 35 kg/m2, and leg or foot fractures within the previous 12 months.
The participants were randomly assigned to receive either THR (n=53, 51% men) or twice weekly 1-hour individual resistance training sessions with a physiotherapist for 12 weeks (n=56, 50% men).
At 6 months, 9% of patents assigned to undergo THR had not received surgery and 21% assigned to resistance training had undergone THR, Frydendal et al point out.
At this timepoint, intention-to-treat analysis showed the THR recipients had significantly superior improvements in the primary outcome of patient-reported pain and function, as assessed using the Oxford Hip Score (OHS) – a 12-item questionnaire that rates hip pain and function on a scale from 0 to 48, with higher scores indicating less pain and better function. Their mean scores increased by 15.9 points, from a presurgery score of 25.4 points, compared with a 4.5-point improvement in the resistance training group, who had a baseline score of 24.8 points
The researchers note that 75% of the patients receiving THR met the OHS criteria for a clinically important treatment response, defined as an increase of at least 8 points, compared with 38% of those receiving resistance training.
The THR group also significantly outperformed the resistance training group on all secondary outcomes at 6 months. These included greater mean improvements on Hip Disability and Osteoarthritis Outcome Score subscales, specifically for pain (39.2 vs 15.0 points), symptoms (39.3 vs 13.6 points), hip-related quality of life (43.5 vs 10.7 points), functions of daily living (32.9 vs 12.1 points), and function in sports and recreation (41.0 vs 9.2 points).
There were also treatment differences in favor of THR for physical activity levels, gait speed, and sit-to-stand function, but in all cases these “did not lead to clinically important greater improvements than resistance training,” the researchers report.
The rate of serious adverse events was similar between the THR and resistance training groups (12 vs 9%), with most events after THR being recognized complications of the surgery, such as hip dislocation or the need for revised surgery.
Frydendal and colleagues acknowledge that the unblinded design “may have resulted in overestimation of the effects of both treatments and the relative benefit of surgery as compared with exercise.”
However, they conclude that “the results support current recommendations for the management of hip osteoarthritis and may be used to inform and guide shared decision making in clinical practice.”
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