Total hip arthroplasty was superior to resistance training, with some caveats.

Although prescribing a trial of physical therapy before referral for total hip arthroplasty (THA) is common practice, we do not have comparisons of outcomes after initial resistance training versus advancing to THA immediately after consultation with an orthopedist. In this Danish trial, 109 patients with severe hip osteoarthritis (OA) were randomised to either immediate THA or twice-­weekly supervised resistance training for 12 weeks. Patients were assessed at six, 12 and 24 months with a validated patient­-reported outcome scale (Oxford Hip Score: range, 0 to 48 points, with higher scores reflecting better outcomes; mean baseline score, 25).

At six months, patients who under­ went THA had significantly greater improvement than did those in the resistance-­training group (16-­point vs 5-point improvement). THA demonstrated sustained superiority at 12 months. Functional-­outcome scores converged at 24 months, largely because 77% of patients who were randomised initially to resistance training crossed over to THA.

Comment: The best time to initiate physical therapy for hip OA probably is before advanced degenerative changes are present. Although some patients in this trial were able to delay or avoid surgery with resistance training, most ended up undergoing THA. Depending on a patient’s preferences, referral for physical therapy initially is reasonable, but most patients with advanced, highly symptomatic hip OA eventually will opt for surgery.

Nolan J. Mischel, MD, Assistant Professor of Medicine, Texas Christian University, Burnett School of Medicine; Core Family Medicine Faculty, John Peter Smith Hospital, Fort Worth, USA.

Frydendal T, et al. Total hip replacement or resistance training for severe hip osteoarthritis. N Engl J Med 2024; 391: 1610-1620.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.