Low rate of patients with hip OA in education, exercise program received THR
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Published results showed a low rate of participants with symptomatic hip OA enrolled in a supervised education and exercise therapy program received a total hip replacement during the 2-year follow-up period.
Researchers assessed the rate of THR among 3,657 participants 45 years of age or older with hip OA who received supervised education and exercise therapy through the Good Life with Osteoarthritis in Denmark program from July 2014 to March 2017. Researchers included demographic and disease-specific baseline characteristics and measures of physical activity and quality of life as potential prognostic factors. Researchers retrieved information on THR from the Danish National Patient Registry and developed a multivariable Cox proportional hazards model.
Results showed 30% of participants received a THR within 2 years, and 60% of the 100 participants already wait-listed for THR had the procedure. Researchers found 14 of the 22 candidate prognostic factors were statistically significant for receiving THR. Male gender, having self-reported radiographic hip OA, being wait-listed for THR and having a higher pain intensity were factors associated with a faster rate of THR, according to results. However, researchers noted predictors of a slower rate of THR included faster walking speed, better hip-related quality of life and having three or more comorbidities.
“The variability in surgeons’ recommendations and practices is an essential contributor to the variability in clinical symptoms among hip participants receiving THR,” the authors wrote. “Thus, especially when THR is interpreted as a proxy for disease progression, it must be kept in mind that multiple factors inevitably influence the decision to perform surgery as well as the prognosis in general.”
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Stine Clausen and colleagues found in a cohort study of 3,657 patients with hip OA undergoing a structured program of supervised education and exercise therapy (Good Life with osteoarthritis in Denmark [GLA:D]) followed-up for 2 years, that 30% at that time had received a THR. They looked at prognostic factors indicating a “higher risk” of having surgery within the 2 years and found male sex, patients already prescribed for surgery and patients with severe pain to be statistically significant factors for receiving THR.
It is of major importance for patients and physicians to know who will benefit from education and training if suffering from hip OA. This study gives you an idea to that, but no evidence can be drawn from it. For this we need a randomized study, where patients are randomly allocated to GLA:D or nothing. In the study, I missed a correlation with the severity of hip OA. Another open question to studies like the present is, “What are the benefit-risk factors for patients with hip OA by having their THR postponed?” A potential complex question to analyze in a controlled way.
However, we as surgeons should not “just do surgery because we can do it.” It is important to send patients for GLA:D if the degree of hip OA is low, especially in the elderly patient.
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