A clinical study by Danish scientists showed that among patients with severe hip osteoarthritis, total hip replacement—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 study was published in The New England Journal of Medicine.
Osteoarthritis, or osteoarthritis, of the hip affects over 33 million people worldwide, leading to significant disability. Total joint replacement, where the hip joint is replaced with an implant, is a definitive treatment. This procedure effectively relieves hip pain, reduces functional impairment, and improves quality of life.
More than a million total hip replacements are performed annually worldwide. However, despite the frequency of total hip replacements, 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 team of physicians led by Thomas Frydendal from the University of Southern Denmark conducted a randomized trial comparing the effectiveness of total hip replacement surgery (THR) and physical rehabilitation with strength training. The study included 109 patients over 50 years of age with indications for hip replacement surgery. Fifty-three patients were in the surgery group, while 56 were in the strength training group. The average patient age 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 THR.
The strength training program was conducted by physical therapists in the form of individual, one-hour sessions twice a 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 alternately for both legs using weight 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 in hip pain and function scores from baseline at six months was 15.9 points on the Oxford Hip Pain and Function Scale in the total hip replacement group, compared with 4.5 points in the strength training group (higher scores indicate higher hip function and lower pain, p < 0.001). Overall, after six months, the total hip replacement group demonstrated significantly greater improvements in function and pain than the strength training group across all hip disability and osteoarthritis outcomes. The authors believe these results may help orthopedists make informed decisions about hip replacement surgery in patients with significant decline in function. However, larger clinical trials would be beneficial to confirm these associations. Learn about which organs and body parts medicine has already learned to transplant (or painlessly remove) in the article "Are There Any Irreplaceables?"
