A clinical study by Danish scientists has shown that among patients with severe osteoarthritis of the hip joint, total hip replacement — replacement with a hip prosthesis — was more effective in reducing pain and joint dysfunction than strength training. The training program included cycling, leg presses, and other exercises. The work was published in The New England Journal of Medicine.
Osteoarthritis, or osteoarthritis, of the hip affects more than 33 million people worldwide, causing significant disability. Total hip replacement, where the hip joint is replaced with an implant, is a radical treatment. This procedure effectively relieves hip pain, reduces functional impairment, and improves quality of life.
More than one million total hip replacements are performed worldwide each year. However, despite the frequency of total hip replacement, there are no randomized trials comparing the effectiveness of this procedure with non-surgical treatments for osteoarthritis, such as physical rehabilitation including strength training.
A group of physicians led by Thomas Frydendal from the University of Southern Denmark conducted a randomized trial comparing the effectiveness of total hip replacement and physical rehabilitation with strength training. The study included 109 patients over 50 years of age with indications for hip replacement surgery. There were 53 people in the surgery group and 56 people in the strength training group. The average age of the patients was 67.6 years, and the average duration of hip symptoms was 1.7 years. A total of 12 patients in the strength training group underwent total hip replacement.
The resistance training program was delivered by physical therapists in one-hour sessions twice per week for 12 weeks. The standard protocol included a 10-minute warm-up on a stationary bike, followed by four resistance exercises (leg press, hip extension, hip flexion, and hip abduction) performed on both legs alternately using resistance machines or cable pulleys for three sets separated by 60 seconds of rest. Over time, the number of repetitions decreased as the training load increased.
The mean increase from baseline in hip pain and function scores at six months was 15.9 points on the Oxford Hip Pain and Function Scale in the arthroplasty group compared with 4.5 points in the strength training group (higher scores indicate higher hip function and less pain, p < 0.001). Overall, the surgery group had greater improvements in function and pain than the strength training group at six months across all measures of hip disability and osteoarthritis outcomes. The authors believe that these results may help orthopedists make informed decisions about hip replacement surgery in patients with significant loss of function. However, larger clinical trials would be helpful to confirm these associations. Read about what organs and body parts medicine has already learned to transplant (or painlessly cut off) in the article “Are There Any Irreplaceable Ones?”