Should They Put Off Hip Replacement Surgery? Save
The NEJM reports what should be obvious to rheumatologists: that older adults with severe hip osteoarthritis should opt for total hip replacement (THR) over conservative exercise measures as THR yields a clinically important improvement in pain and function.
A multicenter, randomized trial compared THR surgery to resistance training in patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery. The primary outcome was the change in patient-reported hip pain and function at 6 months. Outcomes were measured using the Oxford Hip Score (range, 0 to 48, with higher scores indicating less pain and better function).
A total of 109 patients (mean 67.6 years) were randomly assigned to THR (53 patients) or resistance training (56 patients). The mean increase (improvement) in the Oxford Hip Score was 15.9 points for THR vs 4.5 points with resistance training (difference, 11.4 points; 95% confidence interval, 8.9 to 14.0; P<0.001).
At 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. There was no difference in serious adverse events or complications.
The best outcomes were achieved with THR surgery in patients with severe OA hip disease.
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