Total hip arthroplasty versus progressive resistance training in patients with severe hip osteoarthritis: protocol for a multicentre, parallel-group, randomised controlled superiority trial

Thomas Frydendal, Robin Christensen, Inger Mechlenburg, Lone Ramer Mikkelsen, Søren Overgaard, Kim Gordon Ingwersen, Thomas Frydendal, Robin Christensen, Inger Mechlenburg, Lone Ramer Mikkelsen, Søren Overgaard, Kim Gordon Ingwersen

Abstract

Introduction: Hip osteoarthritis (OA) is the leading cause for total hip arthroplasty (THA). Although, being considered as the surgery of the century up to 23% of the patients report long-term pain, and deficits in physical function and muscle strength may persist after THA. Progressive resistance training (PRT) appears to improve multiple outcomes moderately in patients with hip OA. Current treatment selection is based on low-level evidence as no randomised controlled trials have compared THA to non-surgical treatment. The primary aim of this trial is to investigate whether THA followed by standard care is superior to 12 weeks of supervised PRT followed by 12 weeks of optional unsupervised PRT for improving hip pain and function in patients with severe hip OA.

Methods and analysis: This is a protocol for a multicentre, parallel-group, assessor-blinded, randomised controlled superiority trial conducted at four hospitals across three healthcare regions in Denmark. 120 patients aged ≥50 years with clinical and radiographic hip OA found eligible for THA by an orthopaedic surgeon will be randomised to THA followed by standard care, or 12 weeks of PRT (allocation 1:1). The primary outcome will be change in patient-reported hip pain and function, measured using the Oxford Hip Score, from baseline to 6 months after initiating the treatment. Key secondary outcomes will be change in the Hip disability and Osteoarthritis Outcome Score subscales, University of California Los Angeles Activity Score, 40 m fast-paced walk test, 30 s chair stand test and occurrence of serious adverse events. Patients declining participation in the trial will be invited into a prospective observational cohort study.

Ethics and dissemination: The trial has been approved by The Regional Committees on Health Research Ethics for Southern Denmark (Project-ID: S-20180158). All results will be presented in peer-reviewed scientific journals and international conferences.

Trial registration number: ClinicalTrials.gov (NCT04070027).

Keywords: clinical trials; hip; musculoskeletal disorders; orthopaedic & trauma surgery.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
CONSORT flow chart. Expected enrolment, randomisation and follow-up. CONSORT, Consolidated Standards of Reporting Trials; PRT, progressive resistance training; THA, total hip arthroplasty.
Figure 2
Figure 2
Visualisation of anticipated changes in Oxford Hip Score (OHS) in the total hip arthroplasty (THA) group and progressive resistance training (PRT) group at baseline, 3 and 6 (primary endpoint) months after initiating the treatment. Values are mean (95% CIs).

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