A recent study found that total hip surgery substantially reduced hip pain and clinically relevant improvement in hip function than resistance training. This observation was seen in individuals aged 50 years and older suffering from hip osteoarthritis as published in The New England Journal of Medicine.
Hip osteoarthritis is a common disability disorder in old age causing pain, functional impairment, and reduced quality of life. Total hip replacement surgery is a routine procedure for individuals with hip osteoarthritis. Non-surgical procedures like resistance training are one of the common procedures prescribed. However, there is uncertainty in the previous literature on the effectiveness of total hip surgery over resistance training. Hence, researchers from Denmark conducted a trial to evaluate whether total hip replacement would provide superior results regarding alleviation of patient-reported hip pain and improved patient-reported function as compared with resistance training.
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A multicenter, randomized, controlled, superiority trial was carried out by randomly (1:1) assigning the individuals to undergo total hip replacement or to participate in a supervised resistance training program using a computer-generated randomization sequence. Individuals aged 50 years or older who had severe hip osteoarthritis and an indication for total hip replacement based on hip pain, clinical presentation, and radiographic imaging were included in the trial. The total hip surgery included a standard fast-track surgical program while the resistance training included 1-hour, individual, supervised sessions twice weekly for 12 weeks. After the initiation of the trial, follow-ups were carried out at 3, 6, 12, and 24 months. The primary outcome was the change in patient-reported hip pain and function from baseline to 6 months as assessed using the Oxford Hip Score. Secondary outcomes included changes from baseline to 6 months in patient-reported domains of pain, symptoms, function in activities of daily living, hip-related quality of life, and function in sports and recreation.
Findings:
A total of 109 patients (mean age, 67.6 years) were randomly assigned to total hip replacement (53 patients) or resistance training (56 patients).
An improvement (mean increase) was seen in the Oxford hip score by 15.9 points in total hip replacement and 4.5 points in the resistance training group in the intention-to-treat analysis.
The total hip replacement group has shown a significant improvement over the resistance training group in the intent-to-treat analysis.
From baseline to 6 months, 5 patients (9%) who had been assigned to total hip replacement had not undergone surgery, and 12 patients (21%) who had been assigned to resistance training had undergone total hip replacement.
The incidence of serious adverse events at 6 months was similar in the two groups; the majority of such events were known complications of total hip replacement.
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Thus, the study concluded that total hip replacement resulted in a clinically important, superior reduction in hip pain and improved hip function in individuals aged 50 years and older with hip osteoarthritis.
Further reading: Frydendal T, Christensen R, Mechlenburg I, et al. Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis. N Engl J Med. 2024;391(17):1610-1620. doi:10.1056/NEJMoa2400141