Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis

The University of Oslo in Norway conducted a study¹ on the effect of exercise on the long-term need for total hip replacement. Physical activity and patient information are recommended for all patient with osteoarthritis of the hip and knee as first-line treatment. In fact exercise therapy was found to be beneficial in reducing pain and improving function in lower extremity osteoarthritis, although its effect on the long-term need for hip replacement was unknown before this study^2-5.

The scientists compared two groups of patients aged between 40 and 80 with osteoarthritis of the hip who experienced pain for at least three months before the study started and followed them up for six years with total hip replacement surgery as the final point. Both groups received three sessions of an education programme developed for patients with hip osteoarthritis and were then randomized to either an exercise therapy group or a control group. The exercise therapy programme was specifically designed for patients with hip osteoarthritis and consisted of strengthening, flexibility and functional exercise. Patients performed exercise therapy two or three times a week for 12 weeks.

After 7 months, the exercise therapy group reported better WOMAC^* results. Over a 6-year follow-up period, the median time to total hip replacement was 5.4 years in the exercise therapy group and 3.5 years in the control (no exercise) group. The analysis showed that participating in both exercise therapy and education had a protective effect against total hip replacement compared to the control group. Finally, the authors concluded that their study shows that participating in a 12-week exercise therapy programme in addition to patient education can reduce the need for total hip replacement or postpone surgery in patients with osteoarthritis of the hip.

This was the first study to evaluate whether exercise therapy affects the need for total hip replacement in patients with isolated hip OA. Total joint replacement surgery is to be considered in cases of advanced disease with severe pain and functional limitation where other treatment options have failed^6-7. Although, this therapy has increased steadily during the past four decades decreasing healthcare cost sustainability. The finding that exercise therapy can delay total hip replacement is important for healthcare consumption and for patients who may avoid surgery and its potential complications.

In OAFI we truly believe in the importance of hygiene and dietetic measures to prevent and delay the onset and progression of OA. For this reason, we promote a new management model for patients with osteoarthritis in Spain. The ARTRO360 will allow early diagnosis, preventive and rehabilitative intervention, the empowerment of patients and family, continuity of care, the correct therapeutic compliance, the efficient use of resources and the effectiveness in results of this assistance process. ARTRO360 was signed by the main Spanish medical and scientific societies and presented to the health authorities in December 2018.

*A standardized questionnaire used by health professionals to evaluate the condition of patients with osteoarthritis of the knee and hip, including pain, stiffness, and physical functioning of the joints.

Marianna Vitaloni, Ph.D.

Science, Research & Innovation OAFI Foundation

Bibliography

1 Svege I, Fernandes L, Nordsletten L, Holm I, Risberg MA. Long-Term Effect of Exercise Therapy and Patient Education on Impairments and Activity Limitations in People With Hip Osteoarthritis: Secondary Outcome Analysis of a Randomized Clinical Trial Phys Ther. 2016 Jun;96(6):818-27. doi: 10.2522/ptj.20140520. Epub 2015 Dec 17.

2 Dagenais S, Garbedian S, Wai EK. Systematic review of the prevalence of radiographic primary hip osteoarthritis. Clin Orthop Relat Res. 2009;467:623–637

3 Pereira D, Peleteiro B, Araujo J, et al. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage. 2011;19:1270–1285.

4 Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005;365:965–973.

5 Arokoski MH, Haara M, Helminen HJ, Arokoski JP. Physical function in men with and without hip osteoarthritis. Arch Phys Med Rehabil. 2004;85:574–581.

6 Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet 2005; 365:965-73

7 Lohmander LS, Roos Em. Clinical Update: treating osteoarthritis. Lancet 2007; 370:2082-4