Exercise as Medicine During the Course of Hip Osteoarthritis

Inger Mechlenburg; Lisa Cecilie Urup Reimer; Troels Kjeldsen; Thomas Frydendal; Ulrik Dalgas


Exerc Sport Sci Rev. 2021;49(2):77-87. 

In This Article

Exercise as Tertiary Prevention in Studies After THA

Idiopathic primary hip OA is the diagnosis in four of five patients receiving THA.[95] Moreover, 60% of the population are women having a mean age of 70 yr at the time of THA, whereas mean age for men is 67 yr.[95] Reduced muscle strength and function limitations are present both in the early[96–99] and in the late[54] postoperative recovery phase after THA, and the postoperative exercise rehabilitation programs typically aim to address these impairments.

A systematic review from 2015 evaluated the effectiveness of exercise after THA on patient-reported function, performance-based function, QoL, and muscle strength.[100] Because of lack of RCTs, generally small sample sizes, and the unsatisfactory quality of many existing studies, a meta-analysis was not possible to perform. The review suggested that exercises after discharge after THA may potentially benefit patients in terms of patient-reported function, performance-based function (i.e., stair climbing and walking speed), and muscle strength. A recent RCT, not included in the systematic review, investigated the effects of progressive resistance training in patients after THA.[55] Patients younger than 65 yr were randomized to progressive resistance training three times a week up to 3 months postoperatively or to postoperative rehabilitation. Patients performing progressive resistance training were substantially stronger in leg press and abduction in the operated leg than patients performing standard rehabilitation exercises at 3 months (43 and 3 kg, respectively) and at 6 months (30 and 3 kg, respectively) postoperative. One year postoperatively, no between-group differences in muscle strength were found. Furthermore, no statistically significant between-group differences in pain, patient-reported function, and performance-based function were found at any follow-up, which likely reflects that patients did not continue to exercise after cessation of the exercise intervention.[55]

Three RCTs investigated the effectiveness of exercise interventions initiated later than one year after THA.[60,65,69] All three applied home-based exercises with focus on light strengthening, and the interventions had durations ranging from 6 to 12 wk. Two of the studies found significant improvement in performance-based function, that is, gait speed by 6 m·min−1 and cadence by 20 steps·min−1.[60,65] None of the RCTs found significant between-group differences for muscle strength, and none of them measured patient-reported outcomes.

One systematic review investigated effectiveness of type and timing of exercise after THA.[101] Unfortunately, there is only sparse literature to support specific exercise modalities in THA patients. The review found that in the early postoperative phase (<8 wk), the most robust evidence corroborates ergometer cycling and strengthening exercises, whereas in the late postoperative phase (>8 wk), weight-bearing exercises were supported. This information may be used as guidance only because the effects of exercise may vary considerably based on individual patient characteristics and preferences. In addition, dose-response relations between different exercise modalities and effects are difficult to establish due to the generally poor reporting of the interventions in exercise studies. Finally, a systematic review that aimed to assess the effectiveness of exercise interventions after THA for hip OA found insufficient therapeutic validity and potentially high risk of bias in the existing studies, limiting the ability to assess the effectiveness of these interventions after THA.[102] Consequently, the literature must be interpreted cautiously.

In summary, exercise in the early postoperative recovery phase after THA may offer potential tertiary prevention in terms of patient-reported function, performance-based function, and muscle strength. There is only sparse support of effect of exercise initiated in the late recovery phase after THA, and effect has only been shown on performance-based function. Further research is needed to establish the extent to which exercise is effective for patients after THA.