Written by Mary Marschner
Spoon Feed
This Danish study showed that people with severe hip osteoarthritis had greater improvement in functional scores at 6 months after total hip replacement (THR) than patients who did resistance training only.
Synopsis
This multicenter randomized controlled trial included 109 patients aged 50 or older with severe hip osteoarthritis across Denmark, comparing THR to resistance training in improving hip pain and function. At six months, THR resulted in a significantly greater improvement in the Oxford Hip Score (THR 15.9 vs resistance training 4.5, mean difference: 11.4 points; P<0.001), and substantial gains were observed across quality of life and functional metrics. Secondary findings indicated significant benefits for THR in mobility and hip-related outcomes, but physical activity levels improved comparably in both groups. THR demonstrated superior efficacy, supporting its role as a primary intervention for severe hip osteoarthritis. (AI-generated)
For severe osteoarthritis, don’t put off surgery
Total hip replacement surgery is a commitment, and comparing surgical and nonsurgical options is important as we grapple with the questions. When should the patient get surgery? Is there an intervention that can put it off for a while or even indefinitely? The PROHIP trial was small and limited by short follow-up times, but it showed that patients felt and functioned better 6 months after surgery than after 6 months of resistance training. What was impressive to me was, using the Oxford Hip Score, a validated tool measuring the patient’s subjective assessment of pain and functionality, patients saw a mean increase of 15.9 points improving the THR treatment arm to a mean score of 42 of 48 total points for functionality and pain control. Although the number of patients was small, the subjective benefit after surgery was not. Certainly there are limitations when only comparing 100 patients, and I will note that not all the patients who were supposed to have surgery had it, but 77% of patients who were in the resistance training ground ended up having surgery by the 24 month mark. If a patient has significant osteoarthritis and an indication for surgery, I will be encouraging patients to go ahead and schedule it. But they should also do resistance training before, after, and forever.
Source
Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis. N Engl J Med. 2024 Oct 31;391(17):1610-1620. doi: 10.1056/NEJMoa2400141. PMID: 39476341
