Intervention Maps · Osteoarthritis · Joint replacement
When is joint replacement the question?
Bottom line
The trials behind this page enrolled people who were already candidates for joint replacement. In that group, knee replacement plus nonsurgical care beat that package alone at one year, with more serious adverse events. Hip replacement beat resistance training on a six-month hip score. Those are two different joints. Neither finding means exercise was a waste for people who are not already surgical candidates. This isn't arthroscopy.
Who this is for
This page is for people whose clinicians already think replacement may be appropriate, usually because pain and daily life remain badly limited after nonsurgical care. If that isn't you, these trials are not a reason to skip exercise or move straight to surgery.
Guidelines keep replacement later in care: refer when symptoms persist and quality of life is affected despite other care. That's when the question arises. It isn't the trial result itself.
Knee
What the knee evidence shows
A trial of people already eligible for total knee replacement compared surgery plus a 12-week nonsurgical package with the package alone. At 12 months, the replacement group scored about 16 points better on a composite knee measure.
Serious adverse events were more common with replacement (24 people versus 6). Most people assigned to nonsurgical care had not had a knee replacement by one year. The package still did real work. Replacement did more, at a cost.
Same treatment family. Different evidence.
Hip
What the hip evidence shows
A later trial enrolled people aged 50 or older with severe hip osteoarthritis and an indication for surgery. Total hip replacement beat 12 weeks of resistance training on a standard hip score at six months, by about 11 points.
About one in five people assigned to training had crossed over to replacement by six months. Serious adverse events were similar in the two groups; most were known complications of replacement. That isn't the knee trial's harm story, and it isn't a certificate that hip replacement is as gentle as training.
Don't use the knee numbers as if they were hip evidence.
What taking part usually involves
In the studies behind this evidence, replacement meant a major operation, hospital care, and a rehabilitation period measured in weeks to months, not a quick clean-out of the joint.
- A surgical indication that was already on the table, not a first conversation for every painful X-ray.
- Recovery, physiotherapy, and a risk of serious complications.
- A different decision from arthroscopy, which did not beat placebo surgery for degenerative knee disease.
What this does not do
These trials don't rewrite exercise for people who are not already surgical candidates. They also don't make knee replacement speak for the hip, or hip replacement speak for the knee.
Hand surgery is a different question. This page is about the knee and the hip.
Evidence consulted Open sources
Key sources used to prepare this answer. This is not a citation for every sentence.
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