Does total hip replacement with rehab improve hip osteoarthritis scores better than just exercise?
For patients with moderate-to-severe hip osteoarthritis, surgery offers a clear advantage over exercise alone. Clinical trials show that total hip replacement (THA) leads to much larger improvements in pain and function compared to self-directed exercise programs. While exercise helps, it does not match the results of surgery for severe cases.
What the research says
A 2024 trial compared total hip replacement with a self-directed exercise program for patients with moderate-to-severe hip osteoarthritis. At 12 months, the surgery group showed significantly greater improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Harris Hip Score (HHS) than the exercise group 1. The difference in improvement was large, with the surgery group improving by over 27 points on the WOMAC scale compared to a small change in the exercise group 1.
Another 2024 study focused on patients with severe hip osteoarthritis who were assigned to either total hip replacement or resistance training. The surgery group improved their Oxford Hip Score by 15.9 points, while the resistance training group improved by only 4.5 points 4. This difference of 11.4 points was statistically significant, confirming that surgery provides superior short-term relief for severe pain and function 4.
Research also highlights that adding structured rehabilitation to surgery further enhances outcomes. A 2024 study of patients undergoing hip replacement found that combining preoperative and postoperative progressive resistance training led to the most pronounced and sustained gains in muscle strength and gait compared to training alone 5. This suggests that the best results come from pairing the surgery with a specific rehab plan rather than relying on exercise alone.
What to ask your doctor
- What are my specific goals for pain relief and function, and would surgery be necessary to reach them?
- How does my current level of activity affect the choice between surgery and exercise?
- What specific rehabilitation program do you recommend if I choose to have a hip replacement?
- What are the risks of delaying surgery if my osteoarthritis is severe?
This question is drawn from common patient questions about Orthopedics & Sports Medicine and answered using cited medical research. We do not provide individualized advice.