Total hip replacement (THR) significantly outperforms resistance training in alleviating hip pain and improving function for individuals with severe symptomatic hip osteoarthritis, according to a groundbreaking randomized controlled clinical trial.
The PROHIP study, published in the New England Journal of Medicine, revealed a 15.9-point increase in Oxford Hip Scores from baseline to 6 months for the THR group compared to a 4.5-point increase for the resistance training group. This 11.4-point difference signifies a clinically significant improvement favoring THR.
“Our results are clear: Surgery is superior to exercise in patients who have hip osteoarthritis and indication for surgery, and now we have finally proven that with the highest level of evidence,” stated corresponding author Thomas Frydendal, PT, PhD, MSc, from Aarhus University, Denmark.
The PROHIP study, conducted at four Danish orthopedic centers, aimed to compare the effectiveness of THR versus resistance training in managing severe hip osteoarthritis. While THR is typically recommended, robust clinical trial data comparing it directly to first-line treatments like exercise were lacking.
A total of 110 participants, aged 50 or older with hip pain and clinical/radiographic evidence of osteoarthritis, were randomly assigned to either THR or resistance training. Notably, 86% of eligible individuals declined participation, highlighting the challenge of recruiting patients for trials.
Participants in the THR group underwent a “fast track” program encompassing patient education, pain management, and early mobilization. The resistance training group received 12 weeks of supervised physiotherapy followed by 12 weeks of independent exercise.
At 6 months, THR demonstrated significant superiority in pain relief and functional improvement, as measured by the Oxford Hip Score. While resistance training showed benefits, it paled in comparison to the outcomes achieved with surgery.
Consultant orthopedic surgeon Antony Palmer, MA, BMBCh, DPhil, from Oxford University Hospital NHS Foundation Trust, commented, “It’s reassuring that patients with advanced symptomatic osteoarthritis do well with hip replacements.”
While THR carries potential risks, Palmer noted that the rates observed in the study were consistent with expectations. Interestingly, five individuals assigned to THR did not undergo surgery, suggesting that exercise alone might suffice for some patients. Conversely, 12 individuals in the resistance training group opted for THR, indicating potential benefits of early surgical intervention.
Frydendal emphasized that nearly 75% of participants reported no prior supervised exercise, highlighting the importance of considering exercise therapy as a first-line treatment option. However, he stressed, “if our first-line treatment does not offer any improvements in the patient’s symptoms, we should refer the patient if they are eligible for surgery, as surgery with total hip replacement is clearly a really good treatment option.”
These findings provide valuable insights for clinicians and patients facing hip osteoarthritis. While resistance training remains a valuable tool, THR emerges as the superior option for individuals seeking significant pain relief and functional improvement.
**Ready to learn more about hip osteoarthritis treatment options? Consult with your doctor to discuss the best approach for your individual needs.**