Svege Ida, Nordsletten Lars, Fernandes Linda, Risberg May Arna
Department of Orthopaedics, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Oslo, Norway.
Department of Orthopaedics, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
Ann Rheum Dis. 2015 Jan;74(1):164-9. doi: 10.1136/annrheumdis-2013-203628. Epub 2013 Nov 19.
Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown.
We conducted a long-term follow-up of a randomised trial investigating the efficacy of exercise therapy and patient education versus patient education only on the 6-year cumulative survival of the native hip to THR in 109 patients with symptomatic and radiographic hip OA. Results regarding the primary outcome measure of the trial, self-reported pain at 16 months follow-up, have been reported previously.
There were no group differences at baseline. The response rate at follow-up was 94%. 22 patients in the group receiving both exercise therapy and patient education and 31 patients in the group receiving patient education only underwent THR during the follow-up period, giving a 6-year cumulative survival of the native hip of 41% and 25%, respectively (p=0.034). The HR for survival of the native hip was 0.56 (CI 0.32 to 0.96) for the exercise therapy group compared with the control group. Median time to THR was 5.4 and 3.5 years, respectively. The exercise therapy group had better self-reported hip function prior to THR or end of study, but no significant differences were found for pain and stiffness.
Our findings in this explanatory study suggest that exercise therapy in addition to patient education can reduce the need for THR by 44% in patients with hip OA. ClinicalTrials.gov number NCT00319423 (original project protocol) and NCT01338532 (additional protocol for long-term follow-up).
对于所有髋骨关节炎（OA）患者，均推荐进行运动治疗，但其对全髋关节置换术（THR）长期需求的影响尚不清楚。
我们对一项随机试验进行了长期随访，该试验在109例有症状且经影像学检查确诊为髋OA的患者中，研究运动疗法联合患者教育与单纯患者教育相比，对天然髋关节至THR的6年累积生存率的影响。该试验主要结局指标（随访16个月时的自我报告疼痛）的结果已在之前报道。
基线时两组无差异。随访应答率为94%。在随访期间，接受运动疗法联合患者教育组的22例患者和仅接受患者教育组的31例患者接受了THR，天然髋关节的6年累积生存率分别为41%和25%（p=0.034）。与对照组相比，运动疗法组天然髋关节生存的风险比为0.56（可信区间0.32至0.96）。THR的中位时间分别为5.4年和3.5年。运动疗法组在THR前或研究结束前自我报告的髋关节功能更好，但在疼痛和僵硬方面未发现显著差异。
我们在这项解释性研究中的发现表明，对于髋OA患者，运动疗法联合患者教育可使THR需求降低44%。ClinicalTrials.gov编号NCT00319423（原始项目方案）和NCT01338532（长期随访的附加方案）。
