Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis.

For people with severe hip osteoarthritis who are already considered candidates for surgery, there's a real question of whether trying resistance training first might work just as well as going straight to a hip replacement. This trial randomly assigned 109 patients aged 50 or older to either total hip replacement or a structured resistance training program, then compared their hip pain and function six months later using a standard patient-reported scale. The result favored surgery clearly, with a larger improvement in the hip replacement group than in the resistance training group.

That gap was described as clinically important, not just a statistical difference. It's a notable finding because it directly tests an assumption, that exercise could substitute for surgery in this population, and finds it doesn't hold up at six months. The main limitation is the short follow-up: whether resistance training might close the gap over a longer period, or whether some patients could avoid surgery altogether, isn't something this study can answer.

If you've been told you have severe hip osteoarthritis and might need a hip replacement, you may wonder whether exercise could help you avoid surgery. This study looked at exactly that question, comparing hip replacement surgery to a supervised resistance training program in patients who already had an indication for surgery.

Six months later, people who had surgery reported noticeably better pain relief and hip function than those who did resistance training, and the researchers describe this difference as large enough to matter, not just a number on paper. That said, this was a relatively small trial of about 100 people, and it only followed patients for six months. Some people assigned to resistance training later ended up having surgery anyway, and a few assigned to surgery hadn't had it yet by the six month mark, which reflects how messy real-world treatment decisions can be.

Serious complications were similarly uncommon in both groups, mostly related to known surgical risks. This doesn't tell us what happens further down the line, or whether some people might do just as well without surgery over time.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This multicenter randomized controlled trial (PROHIP, NCT04070027) enrolled 109 patients aged 50 and older with severe hip osteoarthritis and an existing indication for surgery, randomizing 53 to total hip replacement and 56 to resistance training. The primary outcome, change in Oxford Hip Score from baseline to six months, showed a mean improvement of 15.9 points with surgery versus 4.5 points with resistance training, a between-group difference of 11.4 points (95% CI, 8.9 to 14.0; P<0.001), favoring surgery and meeting the study's threshold for clinical importance. Crossover was notable: 9% of the surgery group had not yet undergone the procedure by six months, while 21% of the resistance training group had crossed over to surgery, which likely attenuates rather than exaggerates the observed treatment effect under intention-to-treat analysis.

Serious adverse events occurred at similar rates in both arms, predominantly reflecting known surgical complications, so no differential safety signal emerged, though this should not be read as evidence that resistance training carries surgical-level risk or vice versa. The chief limitation is the six-month horizon in a population already selected for surgical candidacy, which constrains inference about longer-term trajectories, delayed benefits of exercise, or whether a subset might avoid surgery indefinitely with conservative management.