Total Hip Replacement Surgery: Exercise May Postpone Need

Ida C. Svege
 PhD student / Physical Therapist 
NAR Norwegian research centre for Active Rehabilitation
Department of Orthopaedics Oslo University Hospital / NIMI / Norwegian School of Sports Sciences
MedicalResearch.com Interview with:
Ida C. Svege
 PhD student / Physical Therapist 
NAR
Norwegian research centre for Active Rehabilitation
Department of Orthopaedics, Oslo University Hospital / NIMI / Norwegian School of Sports Sciences

MedicalResearch.com: What are the main findings of the study?

Answer: The main finding of the study was that exercise therapy in addition to patient education resulted in significantly higher 6-year cumulative survival of the native hip to total hip replacement compared with patient education only. Over the 6 year follow-up period the need for total hip replacement was reduced by 44% in the group who received both exercise therpay and patient education. Also, better self-reported physical function was demonstrated in the group who received exercise therapy and patient education, suggesting that the lower surgery rate in this group were due to better hip function, with or without the presence of pain.

MedicalResearch.com: Were any of the findings unexpected?

Answer: In a previous publication which reported the results of self-reported pain and function, a beneficial effect of exercise therapy and patient education was demonstrated in self-reported physical function, but no difference in self-reported pain was found. Thus, it was somewhat unexpected that the beneficial effect in time to total hip replacement seem to be associated with better physical function rather than perceived pain, as pain often is presented as the patients’ main reason for undergoing surgery. Furthermore, the demonstrated long-term effect of the 12-week exercise programme is noteworthy, and may be associated with an adaptation of the content of the patient education programme and the exercise programme in the long term.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: Patients with hip osteoarthritis presenting with mild to moderate symptoms should be offered a targeted exercise therapy programme in addition to patient education to improve physical function and postpone the need for total hip replacement. Postponing or avoiding surgery is important for healthcare consumptions, and for the patients who may avoid total hip replacement surgery and later revision surgery and its potential complications. Total hip replacement surgery is a good treatment options in cases of advanced disease with severe pain and symptoms, where other treatment modalities have failed. However, in patients with tolerable pain who are able to maintain their desired activity level postponing surgery is appropriate.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: This study is the first to evaluate effect of exercise therapy and patient education by time to total hip replacement, and there is need for future trials to confirm our findings. Furthermore, more studies should be conducted in patients with hip osteoarthritis to evaluate the effect of different exercise therapy interventions, to identify potential mechanisms for the effect of exercise therapy, and to evaluate which patients who are most likely to benefit from exercise therapy.

Citation:

Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial

Ida Svege, Lars Nordsletten, Linda Fernandes, May Arna Risberg

Ann Rheum Dis annrheumdis-2013-203628Published Online First: 19 November 2013 doi:10.1136/annrheumdis-2013-203628

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