Hip Arthritis Physical Therapy No Better than Placebo?
Hip arthritis is a problem that impacts 9-18 million Americans at any given time. At one point or another, many of those patients get sent for hip arthritis physical therapy (PT). Now a new study suggests that all of that PT may not be doing anybody any good.
Hip arthritis is when the hip looses cartilage. The bones then quickly react and bone cysts are common (areas where the bone dies off). Unlike knee arthritis that can slowly worsen over many years, hip arthritis tends to come on fast and hard. That may have to do with the quality of the natural stem cells in the hip which aren’t as robust at repairing cartilage as those found in the knee.
This has been an interesting 10 years in orthopedic outcomes research. First knee surgery for arthritis or meniscus tears turns out to be no better than a fake surgery or physical therapy. Now physical therapy for various conditions may the next victim of the outcome research machinery.
This most recent study was a high quality randomized controlled trial that compared PT to fake treatment. About a hundred patients with 4/10 or worse hip pain due to arthritis were randomized to receive either 10 treatments over 12 weeks of real physical therapy or an ultrasound treatment of the hip with the machine turned off. The fake therapy group actually had slightly more pain relief than the PT group, but the differences weren’t statistically significant. The rest of the function scores were also not different between the groups.
There’s no doubt about it, this study is a really big blow for the physical therapy community. It’s likely that hundreds of thousands of Medicare and other patients are sent for physical therapy to treat hip arthritis every year. Now this study seems to show that Medicare and insurers are wasting their money. In the meantime, it’s important to point out that one of the difficulties with any study of physical therapy practices is that there as many different methods of treating hip arthritis with PT. This study only focused on one of those routines.
The upshot? Will PT for hip arthritis go away? It will be interesting to follow that issue over the next few years as while knee surgery for arthritis and mensicus tears has also been shown not to work, it’s still paid for by insurance companies and it still generates hundreds of thousands of surgeries each year!