全髋关节置换术或抗阻训练治疗严重髋关节骨关节炎。

Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis.

机构信息

From the Departments of Physiotherapy (T.F., K.G.I.) and Orthopedic Surgery (C.V., A.E.G., P.K.-A., P.H.R., C.H.), Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle Hospital, Vejle, the Departments of Clinical Research (T.F., R.C., S.M.N.) and Regional Health Research (C.V., K.G.I.), University of Southern Denmark, and the Research Unit of Rheumatology, Department of Clinical Research (R.C., S.M.N.), and the Department of Orthopedic Surgery and Traumatology (S.O.), Odense University Hospital, Odense, the Section for Biostatistics and Evidence-based Research, Parker Institute, Bispebjerg and Frederiksberg Hospital (T.F., R.C., S.M.N., K.G.I.), the Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg (S.O.), and the Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen (S.O.), Copenhagen, the Department of Orthopedic Surgery, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University, Aarhus (I.M., S.S.J.), the University Clinic for Orthopedic Pathways, Elective Surgery Center, Regional Hospital Silkeborg, Silkeborg (L.R.M.), and the Department of Orthopedic Surgery, Næstved Hospital, Næstved (M.J.B., H.Q., M.S.M.) - all in Denmark.

出版信息

N Engl J Med. 2024 Oct 31;391(17):1610-1620. doi: 10.1056/NEJMoa2400141.

DOI:10.1056/NEJMoa2400141

PMID:39476341

Abstract

BACKGROUND

Total hip replacement is routinely recommended for severe hip osteoarthritis, but data from randomized trials are lacking regarding comparison of the effectiveness of this procedure with that of nonsurgical treatment such as resistance training.

METHODS

We conducted a multicenter, randomized, controlled trial to compare total hip replacement with resistance training in patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery. The primary outcome was the change in patient-reported hip pain and function from baseline to 6 months after the initiation of treatment, assessed with the use of the Oxford Hip Score (range, 0 to 48, with higher scores indicating less pain and better function). Safety was also assessed.

RESULTS

A total of 109 patients (mean age, 67.6 years) were randomly assigned to total hip replacement (53 patients) or resistance training (56 patients). In an intention-to-treat analysis, the mean increase (indicating improvement) in the Oxford Hip Score was 15.9 points in patients assigned to total hip replacement and 4.5 points in patients assigned to resistance training (difference, 11.4 points; 95% confidence interval, 8.9 to 14.0; P<0.001). At 6 months, 5 patients (9%) who had been assigned to total hip replacement had not undergone surgery, and 12 patients (21%) who had been assigned to resistance training had undergone total hip replacement. The incidence of serious adverse events at 6 months was similar in the two groups; the majority of such events were known complications of total hip replacement.

CONCLUSIONS

In patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery, total hip replacement resulted in a clinically important, superior reduction in hip pain and improved hip function, as reported by patients, at 6 months as compared with resistance training. (Funded by the Danish Rheumatism Association and others; PROHIP ClinicalTrials.gov number, NCT04070027.).

摘要

背景

对于严重的髋关节炎，通常建议进行全髋关节置换，但缺乏该手术与非手术治疗（如抗阻训练）效果比较的随机试验数据。

方法

我们开展了一项多中心、随机、对照试验，比较了全髋关节置换与抗阻训练对 50 岁及以上、有严重髋关节炎且需要手术的患者的疗效。主要结局为从治疗开始到 6 个月时，患者报告的髋痛和功能变化，采用牛津髋关节评分（范围 0 至 48 分，得分越高表示疼痛越轻、功能越好）评估。还评估了安全性。

结果

共有 109 例患者（平均年龄 67.6 岁）被随机分配至全髋关节置换组（53 例）或抗阻训练组（56 例）。意向性治疗分析显示，全髋关节置换组患者的牛津髋关节评分平均增加（表示改善）15.9 分，抗阻训练组增加 4.5 分（差值 11.4 分；95%置信区间 8.9 至 14.0；P<0.001）。在 6 个月时，5 例（9%）原本计划接受全髋关节置换的患者未接受手术，12 例（21%）原本计划接受抗阻训练的患者接受了全髋关节置换。两组 6 个月时严重不良事件的发生率相似；大多数此类事件为全髋关节置换的已知并发症。