Surgery is the Optimal Solution for Patients with Severe Hip Osteoarthritis

Hip osteoarthritis is common, especially among older adults, and severe cases are typically treated by replacing the hip joint with an artificial hip. In Denmark, approximately 11,000 hip replacements are performed each year for this condition.

“There has been a need for research that directly compares surgery with exercise for individuals with severe osteoarthritis. Through this randomised trial, we investigated whether one treatment is more beneficial than the other,” explains Thomas Frydendal, PhD and project leader.

The findings were decisive: participants who underwent hip replacement surgery reported greater pain relief and improved daily function compared to those who followed an exercise programme alone.

Surgery Proves Superior, but Exercise Still Has Value

Before joining the study, participants were evaluated as suitable candidates for surgery and were then randomly assigned to either total hip replacement or resistance training. They were informed that if exercise alone did not lead to sufficient improvement, particularly in terms of pain, they could opt for surgery during the trial.

“After six months, 21% of participants in the exercise group had chosen to undergo hip replacement, while two years later, 23% had still not had surgery. While we cannot specify why individual participants chose not to proceed with surgery, this suggests the importance of ensuring patients with severe hip osteoarthritis complete recommended non-surgical treatments, like exercise, before surgical referral,” says Kim Gordon Ingwersen, project initiator and researcher at Department of Regional Health Research.

Additional studies have shown that resistance training can aid individuals with hip osteoarthritis in recovering more quickly after surgery.

Supporting Shared Decision-Making in Treatment Choices

This research provides clinicians and individuals with severe hip osteoarthritis who are candidates for surgery with valuable information about the outcomes they can expect from surgery versus exercise.

“We have demonstrated that total hip replacement is the most effective option, but that exercise may be sufficient for some and often delays the need for surgery. This knowledge can serve as a practical tool in clinical settings to support evidence-based shared decision-making,” Kim Gordon Ingwersen states.

“We anticipated that total hip replacement would likely be superior, but now, with the first randomised trial of its kind globally, we have definitive evidence,” concludes Søren Overgaard, Professor and Orthopaedic Surgeon at Bispebjerg Hospital, adding:

“At the same time, it’s encouraging to see that some individuals manage well with exercise alone. This is valuable insight for treatment planning.”