THA yielded greater improvements in patient pain, function vs. education and exercise
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Key takeaways:
- Total hip arthroplasty had greater clinical improvements for patients vs. education and exercise programs.
- Education and exercise programs showed clinically meaningful improvement rates of up to 30% in patients.
GRAPEVINE, Texas — Results showed total hip arthroplasty may achieve greater pain, function and quality of life improvements in patients with hip osteoarthritis compared with education and exercise programs.
However, researchers found education and exercise programs may also yield clinical benefits in patients with severe OA.
“It appears that education and exercise may have a role to play in condition-centered models of care, including at higher levels of symptom severity,” Michael G. Zywiel, MD, MSc, FRCSC, said during his presentation at the American Association of Hip and Knee Surgeons Annual Meeting. “Even in patients who are good candidates for hip replacement, education and exercise may allow a meaningful proportion of patients to delay or avoid surgery.”
To estimate the treatment effect of education and exercise programs compared with THA in patients with OA, Zywiel and colleagues analyzed data on 266 patients from two prospective registries. Researchers categorized patients into two groups based on whether they underwent THA or utilized education and exercise programs. Outcomes measured included pain, function and quality of life scores at 3 months and 12 months.
“Propensity score matching was performed to try to balance baseline covariates, including demographics, medical status, social status and baseline symptoms,” Zywiel said. “Then that matched cohort was used to perform regression analyses to estimate mean change scores and finally, we estimated the proportion of responders in each group. And we used surgical thresholds for minimally important or clinically important change.”
Zywiel said patients in the THA group had greater mean improvements in pain, function and quality of life vs. patients in the education and exercise cohort. However, he also said the education and exercise cohort had a rate of clinically important improvement between 17% and 30%.
“Further work is certainly needed to confirm these findings in the setting of a clinical trial, and hopefully with socioeconomic analyses,” Zywiel said. “And most importantly, we need to determine how to best target those who will benefit from education and exercise without delaying surgery for those who will not.”
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Zywiel MG, et al. Paper 41. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 2-5, 2023; Grapevine, Texas.
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