‘Reassuring’ Results
In a comment, consultant orthopedic surgeon Antony Palmer, MA, BMBCh, DPhil, said: “It’s reassuring that patients with advanced symptomatic osteoarthritis do well with hip replacements.”
THR does of course come with the potential risk for complications, but “the rate of these is what you’d expect for that procedure,” Palmer said, who works for the Nuffield Orthopaedic Centre, Oxford University Hospital NHS Foundation Trust, and is a senior clinical research fellow at Oxford University in England.
Dr. Palmer
Dr. Antony Palmer
In the THR arm, there was one case of prosthetic joint infection, one hip dislocation, two revision surgeries, one instance of foot drop, and one case of gastroesophageal reflux. Meanwhile, in the resistance training group, there was one hip dislocation, one pelvic fracture, one case of atrial fibrillation, and one urinary tract and renal infection.
Overall, any serious adverse event was reported in six (12%) of 48 patients in the THR arm vs five (9%) of 55 participants in the resistance training group, of which only one, occurring in the resistance training group, resulted in discontinuation of the program.
Resistance Training Role
A notable finding was that, at 6 months, five (9%) people assigned to the THR arm had not undergone surgery, and 12 (21%) people in the resistance training group had undergone a THR.
This could suggest two things, Palmer suggested in the interview. The first is that there could be a small proportion of people assigned to THR who may not need the operation and do well with exercise therapy. And, conversely, there may be those who would do well having the surgery without first going through the intermediate stage of physical therapy.
It’s a suggestion that “maybe we’ve got to refine that a bit better and identify the patients that really do benefit from physiotherapy and who might not need hip replacement as a result,” Palmer said.
Or in other words, “should all patients undergo a program of physiotherapy before considering surgery?” he added.
Authors’ View
The PROHIP investigators conclude: “These results support current recommendations for the management of hip osteoarthritis and may be used to inform and guide shared decision making in clinical practice.”
Moreover, the results “do not oppose the use of resistance training as initial treatment,” says the authors.
Frydendal highlighted in his interview that nearly three out of four of the patients reported not to have undertaken any type of supervised exercise before entry into the study, which is a first-line, guideline-recommended option.
“If a patient tells me, ‘I haven’t done any exercise previously,’ I’d recommend starting with completing a 6- to 12-week exercise program that is tailored to your individual needs and evaluate your symptoms afterward,” he said.
“But we should refer the patient if our first-line treatment does not offer any improvements in the patient’s symptoms, as surgery with total hip replacement is clearly a really good treatment option,” Frydendal said.
The study was funded by the Danish Rheumatism Association, among other independent bodies. Frydendal and Palmer reported no relevant financial relationships.
A version of this article first appeared on Medscape.com.