Published: Nov 22, 2013
By Nancy Walsh, Staff Writer, MedPage Today

Full Story:  http://www.medpagetoday.com/Rheumatology/Arthritis/43073

Full Text Article

A program of exercise therapy helped patients with hip osteoarthritis (OA) avoid total hip replacement surgery, Scandinavian researchers found.

Patients who had both an educational program and exercise had a 44% decrease in the need for hip replacement compared with those who attended the educational sessions and didn’t participate in the exercise program (HR 0.56, 95% CI 0.32-0.96, P=0.036), according to Ida C. Svege, MD, of Oslo University Hospital, and colleagues.

And for those who did require joint surgery, median time to hip replacement was 5.4 years for the exercise group compared with 3.5 years for the education group, the researchers reported online in Annals of the Rheumatic Diseases.

Exercise is considered an important component of therapy for patients with OA of the knee, but evidence for its potential benefit in hip OA has been lacking.

Therefore, Svege and colleagues conducted an exploratory analysis of a randomized trial of exercise versus education in 109 adults with symptomatic and radiographically documented hip OA.

At study entry, none of the patients were considered candidates for total hip arthroplasty according to the investigators’ criteria of the presence of night pain and a Harris hip score lower than 60.

All participants attended three educational sessions about hip OA. Those randomized to the exercise program also had two or three sessions each week of exercises to strengthen and enhance flexibility and function, with at least one of the weekly sessions being led by a physical therapist.

Symptoms and functional status were assessed on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and activity was rated on the Physical Activity Scale for the Elderly (PASE).

At baseline, mean age was 58, and slightly more than half were women. Harris hip score was 78, the disease was bilateral in 70%, and pain duration averaged 4 years.

During follow-up, which ranged from 3.6 to 6.1 years, 22 patients in the exercise group and 31 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 (P=0.034).

A significant between-group difference in WOMAC physical function was seen after 29 months of follow-up (-6.4, 95% CI minus 14.1-minus 1.3, P=0.004), though not in WOMAC pain or stiffness.

“This may indicate that the lower rate and longer time to [total hip replacement] in the exercise therapy group are due to better hip function, with or without the presence of pain,” the researchers observed.

There also were no differences in PASE scores during follow-up.

Rates of total hip arthroplasty have been on the rise for the past 40 years, at considerable cost to the healthcare system.

“Our finding, that exercise therapy enhances the survival of the native hip to [total hip replacement], is therefore important for healthcare consumption and for patients who may avoid surgery and its potential complications,” Svege and colleagues stated.

“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 [total hip replacement] revision surgery,” they concluded.

A limitation of the study was the exclusion of patients with severe pain and knee involvement.