Rates of total hip arthroplasty have risen steadily during the past four decades. Is there a way to avoid a total hip replacement? Exercise. That is the advice Scandinavian researchers give as a result of their study of 109 adults with symptomatic and radiographically documented hip osteoarthritis. Study subjects who participated in both an educational program and an exercise program had a 44% decrease in the need for hip replacement compared with those who attended only the educational sessions and did not participate in the exercise program, according to Ida C. Svege, M.D., of Oslo University Hospital, and colleagues.
For those who eventually did require joint surgery, the median time to hip replacement was 5.4 years for the exercise group. The education-only group had hip replacement surgery after 3.5 years. Nancy Walsh writing for MedPage noted that while exercise has been considered an important component of therapy for patients with osteoarthritis of the knee, evidence of its importance for hip osteoarthritis has been lacking.
The mean age of the study participants was 58 years and more than half were women. Their Harris hip score was 78 and in 70% of the participants the disease was bilateral. Their pain duration averaged four years. All of the participants attended three educational sessions about hip osteoarthritis. Those who were randomized to the exercise program had two or three sessions each week of exercises designed to strengthen and enhance flexibility. At least one of the weekly sessions was led by a physical therapist.
Walsh reported that during follow-up, which ranged from 3.6 to 6.1 years, 22 of the patients in the exercise group and 31 of the controls underwent total hip replacement. On a Kaplan-Maier analysis, cumulative 6-year survival of the original hip was 0.41 in the exercise group and 0.25 in the education-only group.
In their report published in the Annals of the Rheumatic Diseases they concluded, “Our finding, that exercise therapy enhances the survival of the native hip is therefore important for healthcare consumption and for patients who may avoid surgery and its potential complications. We argue that for patients with tolerable pain who are able to maintain their desired activity level and who are relatively young, postponing surgery is appropriate and may reduce the future need for total hip replacement or repetitive revision surgery.”
