Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial
- 1Department of Orthopaedics, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Oslo, Norway
- 2Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
- 3Faculty of Medicine, University of Oslo, Oslo, Norway
- 4Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense C, Denmark
- Correspondence to Ida Svege, Department of Orthopaedics, Oslo University Hospital, Seksjon for forskning og kompetansesenter, Kirkeveien 166, bygg 72 (2. etg), Oslo 0407, Norway;
- Received 15 March 2013
- Revised 4 September 2013
- Accepted 26 October 2013
- Published Online First 19 November 2013
Background Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown.
Methods We conducted a long-term follow-up of a randomised trial investigating the efficacy of exercise therapy and patient education versus patient education only on the 6-year cumulative survival of the native hip to THR in 109 patients with symptomatic and radiographic hip OA. Results regarding the primary outcome measure of the trial, self-reported pain at 16 months follow-up, have been reported previously.
Results There were no group differences at baseline. The response rate at follow-up was 94%. 22 patients in the group receiving both exercise therapy and patient education and 31 patients in the group receiving patient education only underwent THR during the follow-up period, giving a 6-year cumulative survival of the native hip of 41% and 25%, respectively (p=0.034). The HR for survival of the native hip was 0.56 (CI 0.32 to 0.96) for the exercise therapy group compared with the control group. Median time to THR was 5.4 and 3.5 years, respectively. The exercise therapy group had better self-reported hip function prior to THR or end of study, but no significant differences were found for pain and stiffness.
Conclusions Our findings in this explanatory study suggest that exercise therapy in addition to patient education can reduce the need for THR by 44% in patients with hip OA. ClinicalTrials.gov number NCT00319423 (original project protocol) and NCT01338532 (additional protocol for long-term follow-up).
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