By Doug Hanson
All surgery has risks, and a total hip replacement is no exception. Researchers may have found a way for some people with hip pain to avoid or delay the need for this surgery.
Researchers found a reduced need for total hip replacement among patients who received 12 weeks of exercise therapy along with education on their diagnosis.
The study focused on patients who were not yet in need of hip replacement but had at least a three-month history of pain.
Patients who followed the 12-week exercise program more often reported less pain and more mobility.
This study was led by Ida Svege, a PhD student and physical therapist in the Department of Orthopedics at Oslo University Hospital.
The research team studied 109 patients over six years to determine the effectiveness of exercise therapy and education on the need for total hip replacement (THR) in patients with Osteoarthritis (OA) of the hip.
Patients were randomly placed into one of two groups, one receiving both exercise therapy and patient education while the second group received only the education. All patients were diagnosed with equal levels of symptomatic and radiographic hip OA at the beginning of the study.
To be selected for the trial, patients had to be between 40 and 80 years old, have hip pain for at least three months and meet a minimum and maximum damage assessment. This allowed the researchers to exclude patients who were already candidates for THR.
All patients received three group sessions of a patient education program specific to their condition. The exercise group received special exercise therapy two or three times a week for 12 weeks.
The researchers began screening for patients in April 2005 and concluded screening in October 2007.
While there have been studies looking at the effect of exercise on THR, those studies included patients who were also diagnosed with a potential need total knee replacement (TKR) as well. While evidence exists to suggest a positive result, further study was needed.
Over the course of this study, 22 patients from the group receiving exercise required a THR, while education-only patients required 31 THRs. That means the patients who received exercise kept their own hip in 41 percent of the cases, while 25 percent of the education-only group kept their natural hip.
The researchers concluded that participating in a 12-week exercise therapy program along with patient education may lead to a 44 percent improvement in the need for THR over education only.
Eliminating or delaying the need for major THR surgery to reduce the effects of pain and stiffness may provide a safer alternative.
The criteria for when THR surgery was required were not specified and can vary between hospitals. These results only apply to patients with symptomatic and radiographic hip OA, with mild to moderate symptoms. There is not a consensus on when surgery is most beneficial and many factors must be taken into account.
This study was published on November 19 in the Annals of the Rheumatic Diseases.
This study was supported by grants from the former science council at Ullevaal University Hospital, Oslo and the EXTRA funds from the Norwegian Foundation for Health and Rehabilitation through the Norwegian Rheumatism Association.
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