Total Hip Arthroplasty versus Education and Exercise: A Secondary Analysis of Propensity Matched Data Comparing Outcomes Across Hip Osteoarthritis Symptom Severity

James J Young; Michael G Zywiel; Søren T Skou; Vinod Chandran; J Rod Davey; Rajiv Gandhi; Nizar N Mahomed; Khalid Syed; Christian J H Veillette; Y Raja Rampersaud; Anthony V Perruccio

doi:10.1016/j.arth.2025.04.032

Total Hip Arthroplasty versus Education and Exercise: A Secondary Analysis of Propensity Matched Data Comparing Outcomes Across Hip Osteoarthritis Symptom Severity

J Arthroplasty. 2025 Sep;40(9S1):S246-S252. doi: 10.1016/j.arth.2025.04.032. Epub 2025 May 13.

Authors

Affiliations

¹ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark.
² Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark; The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
⁴ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
⁵ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.

PMID: 40841100
DOI: 10.1016/j.arth.2025.04.032

Abstract

Background: Using propensity-matched data, we have previously shown that total hip arthroplasty (THA) provides superior outcomes to an education and exercise (Edu + Ex) program in patients who have hip osteoarthritis (OA), overall. This study investigated whether treatment effects of Edu + Ex versus THA differ across patients who have varying degrees of hip OA symptom severity.

Methods: This was a secondary analysis of propensity-matched patients who had hip OA who underwent THA or an Edu + Ex program (1:1 match ratio). In this analysis, matched patients were divided into three strata based on their propensity score (low severity: < 0.33; moderate severity: ≥ 0.33 and < 0.67; and high severity: ≥ 0.67). The propensity score reflected symptom severity, and a greater score indicated more severe symptoms. Between-group treatment effects (pain, function, and quality of life) were estimated as the mean difference (MD) in change from pretreatment to three and 12 months postintervention using linear mixed models within each severity stratum.

Results: Patients (n = 266) were classified into three strata: low symptom severity (n = 55), moderate symptom severity (n = 115), and high symptom severity (n = 96). Treatment effects at 12 months revealed statistically significant differences in favor of THA over Edu + Ex across all three severity strata for pain (low: MD 26.3, 95% confidence interval [CI] 18.6 to 33.9; moderate: MD 35.6, 95% CI 30.0 to 41.2; high: MD 40.0, 95% CI 32.5 to 47.4) and for function and quality of life. All estimated treatment effects were clinically relevant.

Conclusions: From this analysis of well-matched observational data, we identified a clinically relevant effect in favor of THA over Edu + Ex across all outcomes, regardless of hip OA symptom severity. These findings question whether THA should be prioritized only for those patients who have severe hip OA symptoms, but require confirmation in a trial.

Keywords: education; exercise; hip osteoarthritis; symptom severity; total hip arthroplasty.

Publication types

Comparative Study

MeSH terms

Aged
Arthroplasty, Replacement, Hip*
Exercise Therapy*
Female
Humans
Male
Middle Aged
Osteoarthritis, Hip* / rehabilitation
Osteoarthritis, Hip* / surgery
Osteoarthritis, Hip* / therapy
Patient Education as Topic*
Propensity Score
Quality of Life
Severity of Illness Index
Treatment Outcome