严重髋关节骨性关节炎的全髋关节置换术还是阻力训练?

IF 96.2 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL New England Journal of Medicine Pub Date : 2024-10-31 DOI:10.1056/NEJMoa2400141
Thomas Frydendal, Robin Christensen, Inger Mechlenburg, Lone R Mikkelsen, Claus Varnum, Anders E Graversen, Per Kjærsgaard-Andersen, Peter H Revald, Christian Hofbauer, Manuel J Bieder, Haidar Qassim, Mohammad S Munir, Stig S Jakobsen, Sabrina M Nielsen, Kim G Ingwersen, Søren Overgaard
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引用次数: 0

摘要

背景:全髋关节置换术是治疗严重髋关节骨性关节炎的常规建议,但缺乏随机试验的数据,无法比较该手术与阻力训练等非手术治疗的效果:我们进行了一项多中心随机对照试验,对 50 岁或以上患有严重髋关节骨关节炎且有手术指征的患者进行全髋关节置换术与阻力训练的比较。主要结果是患者报告的髋关节疼痛和功能从基线到治疗开始后 6 个月的变化,使用牛津髋关节评分进行评估(范围从 0 到 48,分数越高表示疼痛越轻、功能越好)。此外,还对安全性进行了评估:共有 109 名患者(平均年龄 67.6 岁)被随机分配接受全髋关节置换术(53 人)或阻力训练(56 人)。在意向治疗分析中,接受全髋关节置换术的患者的牛津髋关节评分平均提高了 15.9 分,而接受阻力训练的患者的牛津髋关节评分平均提高了 4.5 分(差异为 11.4 分;95% 置信区间为 8.9-14.0 分):对于 50 岁或以上患有严重髋关节骨关节炎且有手术指征的患者,与阻力训练相比,全髋关节置换术可在 6 个月后显著减轻髋关节疼痛并改善髋关节功能。(由丹麦风湿病协会和其他机构资助;PROHIP ClinicalTrials.gov 编号:NCT04070027)。
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Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis.

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.).

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来源期刊
New England Journal of Medicine
New England Journal of Medicine 医学-医学:内科
CiteScore
145.40
自引率
0.60%
发文量
1839
审稿时长
1 months
期刊介绍: The New England Journal of Medicine (NEJM) stands as the foremost medical journal and website worldwide. With an impressive history spanning over two centuries, NEJM boasts a consistent publication of superb, peer-reviewed research and engaging clinical content. Our primary objective revolves around delivering high-caliber information and findings at the juncture of biomedical science and clinical practice. We strive to present this knowledge in formats that are not only comprehensible but also hold practical value, effectively influencing healthcare practices and ultimately enhancing patient outcomes.
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