Exercise May Delay or Prevent Hip Surgery
Patients who were in an exercise program were less likely to need replacement surgery.
People with mild to moderate hip osteoarthritis (OA) may be able to avoid hip surgery if they exercise, according to a study published recently online in Annals of the Rheumatic Diseases. The study showed that people who participated in an exercise program for one hour at least twice a week for 12 weeks were 44 percent less likely to need hip replacement surgery six years later compared with a similar group of people who did not exercise. Also, those who exercised reported improved flexibility and ability to perform physical activities compared with those who did not exercise.
“The take away message from our study is that all patients with mild to moderately symptomatic hip osteoarthritis, with tolerable pain, should be offered a targeted exercise therapy program in addition to patient education to improve physical function and postpone the need for total hip replacement surgery,” says lead study author Ida Svege, a PhD candidate, from Norwegian Research Centre for Active Rehabilitation at Oslo University Hospital in Norway.
This is the first study to show that exercise therapy can avoid the need for total hip replacement in people with hip OA. The authors say they expected the study to show that exercise had no effect on the need for hip surgery and were surprised by their results. But they emphasize that the findings do not apply to people with severe hip OA, knee OA or back pain because the effect of exercise was not studied in these groups.
The study included 109 people, between the ages of 40 and 80 years, with mild to moderate hip OA in one or both hips (confirmed on X-ray). None of the participants were planning to have hip replacement surgery at the time they enrolled in the study.
All participants attended three group sessions of patient education designed for people with hip OA. They were then randomly assigned to an exercise program or none (both groups were similar at the start of the study in terms of age, severity of hip OA, gender, and other factors). Those in the exercise program participated in one hour of strengthening, flexibility, and functional exercises two or three times a week for 12 weeks. A physical therapist supervised them at least once a week (patients were considered “compliant” if they attended the program for at least 20 of 24 sessions). People who were not assigned to exercise had a two-month follow-up visit in the physical therapy clinic.
During approximately six years of follow-up, hip surgery was performed in 22 patients in the exercise group and 31 patients in the group receiving only patient education – a statistically significant difference. Furthermore, the time until needing hip surgery was prolonged by about two years in those assigned to exercise: a median of 5.4 years compared to 3.5 years for people in the group that did not exercise. Additionally, those who participated in exercise therapy said that had better hip function than those not assigned to exercise. There was no significant difference between the two groups for pain and stiffness.
“These findings support the general clinical recommendations stating that patients diagnosed with hip OA should be offered patient education and exercise therapy as the first treatment approach,” says Svege. “This is important for patients who may avoid surgery and its potential complications.”
Although the study did not document whether any of the patients continued to exercise beyond 12 weeks, Ms. Svege says, “I would absolutely recommend patients with hip OA to continue to exercise, and in fact, all patients in this study were advised to increase or maintain their level of activity.”
She notes that total hip replacement surgery remains a good option for people with advanced disease, severe pain, and functional limitations.
“This study is of interest, and may reflect the fact that those who exercise have less pain than those who do not. The main reason for surgery is pain,” says Scott Zashin, MD, a rheumatologist in private practice in Dallas, Texas.
Dr. Zashin said that it was notable that there was less progression of joint disease (as seen on X-ray) in patients who exercised compared to those who did not, whether or not they had surgery.