Objective:To investigate whether improvements in sleep quality and duration are associated with improvements pain and physical function in people with hip osteoarthritis (OA) following exercise. Methods:Data from 185 participants with hip OA, randomized to an exercise intervention were pooled and analysed. Independent variables were changes in sleep quality using the Pittsburgh Sleep Quality Index (PSQI; 0-21, higher scores indicating poorer sleep) and sleep duration (hours) at 3 and 9 months. Outcomes were changes in hip pain severity (11-point numerical rating scale; 0-10) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index; 0-68). Associations were examined using linear regression models, adjusted for baseline values and covariates, and according to baseline sleep quality (PSQI >5 = poor sleep; ≤5 = good sleep). Results:At 3 months, each 1-point improvement in sleep quality was associated with reduced pain (-0.21 units; 95% CI: -0.32 to -0.09) and improved physical function (-1.45 units; 95% CI: -2.01 to -0.89). Each 1-h increase in sleep duration was associated with reduced pain (-0.34 units; 95% CI: -0.69 to 0.02) and improved physical function (-3.23 units, 95% CI -4.97 to -1.49). Similar associations were observed at 9 months. There were no statistically significant interactions between baseline sleep quality status (p = 0.055 to 0.994) and pain/physical function. Conclusion:Improvements in sleep quality and duration are associated with small improvements in pain and physical function following exercise. These relationships were consistent over time but of uncertain clinical relevance.

BackgroundRising demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA) places significant pressure on healthcare systems. Routine in-person follow-up is resource-intensive and may limit access for new or higher priority patients. The Connected Care protocol integrates telehealth with patient-reported outcome measures (PROMs) to support a more efficient and patient-centred model of post-operative care.MethodsOver 2 years in a public health institution, all THA and TKA patients completed routine pre-operative and post-operative PROMs. Patients scoring ≤27 on the Oxford hip score or Oxford knee score, and/or requested further clinical review, were triaged to telehealth consultation. Following telehealth assessment, patients were either booked for face-to-face review, discharged from routine follow-up, or managed with ongoing remote monitoring.Results1272 patients returned PROMs. Of these, 451 patients (35.5%) scored ≤27 and/or requested further review. Following telehealth consultation, 47 (10.4%) were discharged from face-to-face care, while 71 (15.7%) previously discharged had appointments reinstated for timely in-person review. Among 821 patients (64.5%) who scored >27 and did not request further review, 169 (20.6%) had pre-existing face-to-face appointments cancelled. Overall, the Connected Care protocol generated 216 additional orthopaedic outpatient appointment slots over the 24-month period.DiscussionPROM-guided telehealth triage enabled risk-stratified, patient-centred follow-up post-THA/TKA, improving outpatient capacity within a publicly funded orthopaedic service. It reduced low-value outpatient encounters while preserving access to face-to-face care when clinically indicated. Future development should incorporate post-operative radiographic review, extend the model to other orthopaedic pathways, and enhance cultural and linguistic accessibility to support equitable digital post-operative care.

OBJECTIVE:The objective of this study was to estimate the minimal important change (MIC) and minimal clinically important difference (MCID) for pain and physical function in individuals with hip osteoarthritis (OA) following a physiotherapist-guided exercise intervention. METHODS:Secondary analysis from a randomized controlled trial of 196 adults with hip OA allocated one of two nine-month exercise programs. Patient-reported outcomes measures for hip pain severity (Numeric Rating Scale [NRS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain subscale) and physical function (WOMAC physical function subscale, Patient-Specific Functional Scale [PSFS]) were collected at baseline and three and nine months. Global ratings of change in pain and physical function at three and nine months served as anchors. RESULTS:MIC estimates were 2.1 and 2.4 points for NRS pain at three and nine months, respectively; 2.8 and 3.0 points for WOMAC pain at three and nine months, respectively; 8.7 and 8.3 points for WOMAC physical function at three and nine months, respectively; and -2.1 and -2.0 points for PSFS at three and nine months, respectively. The MCID estimates were 2.0 and 2.4 points for NRS pain at three and nine months, respectively; 2.8 and 3.0 points for WOMAC pain at three and nine months, respectively; 9.2 and 8.3 points for WOMAC physical function at three and nine months, respectively; and -3.5 and -0.7 points for PSFS at three and nine months, respectively. CONCLUSION:This study provides robust, context-specific MIC and MCID estimates for outcomes in hip OA following exercise. These values can inform the interpretation and design of exercise-based clinical trials for hip OA.

RATIONALE:Hip osteoarthritis is a major public health issue. International treatment guidelines recommend exercise to manage symptoms. This is an update of a review first published in 2009 and last updated in 2014. OBJECTIVES:To determine the effects of land-based exercise on pain, physical function, quality of life, participant-reported treatment success, study withdrawals, and adverse events in people with hip osteoarthritis. SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase, and two trial registries from February 2013 (search date for last update) to 5 February 2025. We also checked reference lists for additional studies. ELIGIBILITY CRITERIA:We included randomised controlled trials (RCTs) of adults with hip osteoarthritis. Eligible comparisons were as follows. • Exercise versus attention control/placebo. • Exercise versus no treatment/usual care/limited education. • Exercise plus a co-intervention (A) versus the co-intervention (A) alone. We excluded perioperative exercise programmes; interventions involving vibration therapy, gait aids, or retraining; and studies that added unequal co-interventions in both groups or that compared only one form of exercise to another. OUTCOMES:Our critical outcomes were pain, physical function, and quality of life. Our important outcomes were participant-reported treatment success, study withdrawals, and adverse events. RISK OF BIAS:As this was a review update, we used the original Cochrane risk of bias tool (RoB 1). SYNTHESIS METHODS:We used standard methodological procedures expected by Cochrane. We synthesised results for each outcome using random-effects meta-analysis where appropriate. We used the GRADE approach to assess certainty of evidence. INCLUDED STUDIES:Eighteen studies (1368 participants) met our inclusion criteria. Two studies (123 participants) evaluated exercise versus attention control or placebo, 10 studies (494 participants) evaluated exercise versus no treatment/usual care/limited education, and seven studies (751 participants) evaluated exercise plus a co-intervention (A) versus the co-intervention (A) alone. One trial (210 participants) included two comparator categories. Most studies were small and unblinded. SYNTHESIS OF RESULTS:We converted all continuous effect estimates from standardised mean differences to mean differences (MDs) on a scale of 0 to 100. For pain and physical function, a negative MD indicates an improvement, while for quality of life, a positive MD indicates an improvement. Pain, physical function, quality of life, and participant-reported treatment success were measured immediately after treatment, while study withdrawals and adverse events were recorded at the end of follow-up. Exercise versus attention control/placebo Exercise, compared to attention control/placebo, may have little to no effect on pain (MD -6.31 points, 95% confidence interval (CI) -12.98 to 0.35; 2 studies, 123 participants; low certainty). Exercise may improve physical function slightly (MD -7.44 points, 95% CI -13.86 to -1.01; 2 studies, 123 participants; low certainty). No studies reported quality of life or participant-reported treatment success. Exercise may have little to no effect on study withdrawals (relative risk (RR) 0.83, 95% CI 0.23 to 3.03; 1 study, 106 participants; low certainty). Exercise may increase the risk of adverse events, but the evidence is very uncertain (RR 8.00, 95% CI 1.13 to 56.79; 1 study, 18 participants; very low certainty). Exercise versus no treatment/usual care/limited education Exercise, compared to no treatment/usual care/limited education, probably reduces pain slightly (MD -7.19 points, 95% CI -10.70 to -3.68; 9 studies, 449 participants; moderate certainty) and probably improves physical function slightly (MD -8.79 points, 95% CI -12.00 to -5.41; 9 studies, 447 participants; moderate certainty); however, these improvements are unlikely to be clinically meaningful. Exercise probably has little to no effect on quality of life (MD 2.31 points, 95% CI -1.15 to 5.91; 6 studies, 279 participants; moderate certainty). Exercise may have little to no effect on participant-reported treatment success (RR 1.57, 95% CI 0.62 to 3.99; 2 studies, 69 participants; low certainty) or study withdrawals (RR 1.51, 95% CI 0.80 to 2.86; 7 studies, 404 participants; low certainty). Exercise may have little to no effect on adverse events, but the evidence is very uncertain (RR 2.95, 95% CI 0.62 to 13.96; 6 studies, 257 participants; very low certainty). Exercise plus a co-intervention (A) versus the co-intervention (A) alone Exercise plus a co-intervention (A), compared to the co-intervention (A) alone, probably has little to no effect on pain (MD -3.86 points, 95% CI -8.07 to 0.35; 7 studies, 751 participants; moderate certainty), physical function (MD -2.37 points, 95% CI -6.59 to 1.86; 7 studies, 751 participants; moderate certainty), or quality of life (MD 3.60 points, 95% CI -1.30 to 8.36; 4 studies, 456 participants; moderate certainty). Exercise may have little to no effect on participant-reported treatment success (RR 1.25, 95% CI 0.62 to 2.54; 2 studies, 399 participants; low certainty), and probably has little to no effect on study withdrawals (RR 0.85, 95% CI 0.55 to 1.32; 6 studies, 683 participants; moderate certainty). Exercise probably reduces the risk of adverse events slightly (RR 0.75, 95% CI 0.58 to 0.97; 6 studies, 731 participants; moderate certainty). AUTHORS' CONCLUSIONS:Compared with attention control or placebo, exercise may have little to no effect on pain and may improve physical function slightly. There was no evidence for quality of life or participant-reported treatment success. Exercise may have little to no effect on withdrawals. Evidence regarding adverse events is very uncertain. Compared with no treatment, usual care or limited education, exercise probably improves pain and physical function slightly, although these effects are unlikely to be clinically meaningful. Exercise probably has little to no effect on quality of life and may have little to no effect on participant-reported treatment success or withdrawals. Evidence regarding adverse events is very uncertain. Exercise plus a co-intervention (A), compared to the co-intervention (A) alone, probably has little to no effect on pain, physical function, quality of life, and study withdrawals, and may have little to no effect on participant-reported treatment success. Exercise probably reduces the risk of adverse events slightly. FUNDING:No funding. REGISTRATION:The original protocol was for a review on exercise for osteoarthritis of the hip or knee (https://doi.org/10.1002/14651858.CD004376). The review on hip osteoarthritis alone was first published in 2009 (https://doi.org/10.1002/14651858.CD007912), and last updated in 2014 (https://doi.org/10.1002/14651858.CD007912.pub2).

PURPOSE:Achieving neutral coronal mechanical alignment in knee arthroplasty is traditionally considered crucial for implant longevity and function. However, recent studies suggest alternative alignment strategies. This study examines the correlation between preoperative and postoperative coronal alignment and patient-reported outcome measures (PROMs) at midterm follow-up. We hypothesised that preserving a patient's constitutional alignment would yield superior results, whereas overcorrection toward neutral alignment would lead to poorer outcomes. METHODS:Data from 369 knee arthroplasties in 335 patients at a tertiary hospital, all performed aiming for mechanical alignment, was analysed. Coronal alignment and joint line obliquity were measured pre- and postoperatively using long-leg radiographs. coronal plain alignment of the knee (CPAK) classification was determined. PROMs, including the Oxford knee score (OKS), pain visual analogue scale (VAS) and EuroCol 5-dimensions (EQ.5D) VAS scores, were collected with a mean (standard deviation) follow-up period of 5.7 (1.6) years. Logistic regression was used to assess the association between coronal radiological measurements, CPAK classification, and PROMs, adjusting for age, sex and body mass index (BMI). RESULTS:No significant association was observed between maintaining the same coronal CPAK phenotype at the mid-term follow-up and patient outcomes. Patients who achieved postoperative neutral coronal alignment had a comparable mean OKS yet demonstrated a higher likelihood of reporting an excellent OKS. In cases where coronal alignment was over-corrected and crossed over from valgus to varus or vice versa, the OKS was 5.3 points lower (-9.3, -1.2, 95% confidence interval [CI]: p = 0.011), with an odds ratio [OR] of 3.1 (1.5, 6.7, 95% CI: p = 0.003) for a poor OKS, comparing patients who did not cross over to the opposite coronal alignment. CONCLUSION:At the mid-term follow-up, patients with postoperative neutral coronal alignment demonstrated similar outcomes to those who maintained their preoperative constitutional alignment. Patients who had crossover from varus to valgus or vice versa exhibited significantly poorer results. LEVEL OF EVIDENCE:Level II.

OBJECTIVE:We determine whether there is a relationship between the number of different lower-limb resistance exercises prescribed in a program and outcomes for people with knee osteoarthritis. METHODS:We used a systematic review with meta-regression. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to January 4, 2024. We included randomized controlled trials that evaluated land-based resistance exercise for knee osteoarthritis compared with nonexercise interventions. We conducted meta-regressions between number of different exercises prescribed and standardized mean differences (SMDs) for pain and function. Covariates (intervention duration, frequency per week, use of resistance exercise machine[s], and comparator type) were applied to attempt to reduce between-study heterogeneity. RESULTS:Forty-four trials (3,364 participants) were included. The number of resistance exercises ranged from 1 to 12 (mean ± SD 5.0 ± 3.0). Meta-regression showed no relationship between the number of prescribed exercises and change in pain (slope coefficient: -0.04 SMD units [95% confidence interval {95% CI} -0.14 to 0.05]) or self-reported function (SMD -0.04 [95% CI -0.12 to 0.05]). There was substantial heterogeneity and evidence of publication bias. However, even after removing 31 trials that had overall unclear/high risk of bias, there was no change in relationships. CONCLUSION:There was no relationship between the number of different lower-limb resistance exercises prescribed in a program and change in knee pain or self-reported function. However, given that we were unable to account for all differences in program intensity, progression, and adherence, as well as the heterogeneity and overall low quality of included studies, our results should be interpreted with caution.

BACKGROUND:Exercise is recommended to manage hip osteoarthritis, but weight loss recommendations are conflicting. OBJECTIVE:To evaluate the efficacy of a weight loss diet added to exercise on change in hip pain. DESIGN:2-group superiority randomized trial. (ClinicalTrials.gov: NCT04825483). SETTING:Community. PARTICIPANTS:101 adults with hip osteoarthritis and overweight or obesity. INTERVENTION:Both the exercise only group and very-low-calorie diet (VLCD) plus exercise group were provided with a 6-month home exercise program via 5 telehealth consultations. The VLCD plus exercise group also received a VLCD via 6 telehealth consultations. MEASUREMENTS:The primary outcome was 6-month change in hip pain severity (11-point scale; range 0 to 10, with higher scores indicating worse pain; minimum clinically important difference of 1.8). Secondary end points included other measures of hip pain, physical function, quality of life, body weight, body composition, and adverse events. RESULTS:99 (98%) and 95 (94%) participants provided 6- and 12-month primary outcomes, respectively. Although VLCD plus exercise lost 8.5% more weight than exercise only, VLCD plus exercise was not more effective for change in hip pain severity (mean difference, -0.6 units [95% CI, -1.5 to 0.3]) at 6 months. Between-group differences for other secondary outcomes at 6 months favored VLCD plus exercise except Hip Disability and Osteoarthritis Outcome Score (HOOS) pain and function. At 12 months, weight, body mass index, HOOS pain and function, and overall hip improvement, but not quality of life and physical activity, favored VLCD plus exercise. There were no serious related adverse events. LIMITATION:Participants were unblinded. CONCLUSION:Adding a weight loss diet to exercise did not change hip pain but improved most secondary outcomes. PRIMARY FUNDING SOURCE:National Health and Medical Research Council.

BackgroundFirst-line management for hip and knee osteoarthritis includes lifestyle treatments, such as exercise and weight loss (if appropriate), whereas joint replacement surgery is recommended only for severe symptoms after these options have been exhausted. However, many people with osteoarthritis hold misconceptions about the condition, leading to lower acceptance of nonsurgical treatments, such as exercise, and the mistaken belief that surgery is their only option. Novel patient education approaches that address these misconceptions are recommended to improve uptake of lifestyle treatments, reduce unnecessary surgery, and improve outcomes for people with osteoarthritis. We developed a 4-week self-directed consumer e-learning course on osteoarthritis management. In a randomized controlled trial, using the course led to immediate and sustained improvements in osteoarthritis knowledge. However, participants’ perspectives on the course and an understanding of how it impacted osteoarthritis beliefs, treatment choices, and outcomes were unknown. ObjectiveThis study aims to explore how an e-learning course for people with hip and knee osteoarthritis may have impacted their osteoarthritis beliefs, treatment choices, and outcomes. MethodsIn this qualitative study, we conducted semistructured individual interviews (N=20) with randomized controlled trial participants with hip or knee osteoarthritis who accessed a 4-week consumer e-learning course on osteoarthritis and its management. Interviews were audio recorded, transcribed verbatim, and thematically analyzed following a framework approach, which was guided by the common sense model of self-regulation. ResultsFour themes were developed from the interviews: (1) participants reshaped their beliefs and attitudes toward osteoarthritis and its management, (2) participants adopted a proactive approach to management, (3) participants developed a more positive mindset, and (4) the course supported learning and shifts in beliefs. ConclusionsThe e-learning course resulted in shifts in participants’ beliefs and attitudes toward osteoarthritis and its management, increasing their confidence in living with osteoarthritis and resulting in a more optimistic outlook on the future. The e-learning course is freely available and could be a useful resource for people with osteoarthritis to enhance their understanding of the condition and its management.

OBJECTIVE:To assess whether there is an association between total prescribed dosage of resistance exercise (volume, frequency, intensity, and duration) and change in pain and physical function in individuals with knee osteoarthritis (OA). METHOD:A systematic review with meta-regression was conducted, searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials until December 11, 2024. We included randomised controlled trials that compared resistance exercise for knee OA with non-exercise interventions. Meta-regression examined the association between total prescribed exercise dosage (volume × frequency × intensity × duration of the intervention) and standardised mean differences (SMDs) for change in pain and physical function. Covariates were included to attempt to reduce between-study heterogeneity. RESULTS:Analysis of 14 trials (N = 1274) found no association between total prescribed resistance exercise dosage and changes in pain (slope coefficient: < 0.01 on a 0-100 scale [95% CI: < - 0.01 to < 0.01]; p = 0.18) or physical function (slope coefficient: < 0.01 on a 0-100 scale [95% CI: < - 0.01 to < 0.01]; p = 0.15). Heterogeneity was substantial (I2 = 73%-97%) and many trials were of unclear/high risk of bias. CONCLUSION:No association was found between the total prescribed dosage of resistance exercise and changes in pain or function in individuals with knee OA. However, due to the limited number of trials, high heterogeneity, and overall low quality of studies, findings should be interpreted with caution.

Altered hip loading and biomechanics in individuals with femoracetabular impingement syndrome (FAIS) may affect the joint's habitual mechanical environment, potentially increasing the risk of osteoarthritis . Examining differences in contributions of muscle and external loads (i.e., gravitational and intersegmental-inertial forces) to hip contact forces, compared with controls, may aid our understanding of FAIS pathomechanics and assist with the development of more effective treatments. Whole-body motion and electromyograms of 14 lower limb muscles were acquired from 41 participants with FAIS and 24 healthy controls whilst walking overground at self-selected speed. Contributions made by muscle and external (gravitational and intersegmental-inertial) forces to hip contact force during the stance phase of walking were estimated using an electromyogram-assisted neuromusculoskeletal model and compared between-groups using statistical parametric mapping. Throughout stance, muscle contributed ∼80% of hip contact force for both participants with FAIS and controls. Compared with controls, participants with FAIS generated ∼20% lower total muscle force (mean difference: -0.75 N·BW-1, 95% CI -1.13 to - 0.35, p < 0.001) primarily due to lower adductor (-0.27 N·BW-1, 95% CI -0.48 to - 0.06, p = 0.001), extensor (-0.40 N·BW-1, 95% CI - 0.65 to -0.16, p < 0.001) and flexor (-0.71 N·BW-1, 95% CI -1.07 to -0.35, p < 0.001) muscle group forces at different stages of stance. Compared with controls, lower hip contact force in participants with FAIS during the stance phase of walking were the result of lower flexor, extensor and adductor muscle forces and could be targeted in non-operative interventions (e.g., physiotherapy).

Background Exercise is recommended for hip osteoarthritis, but the most effective programmes for management of symptoms are unknown. We aimed to investigate whether adding aerobic physical activity to resistance exercise would improve hip pain and function more than resistance exercise alone in individuals with hip osteoarthritis. Methods PHOENIX was a randomised comparative effectiveness trial done in Melbourne, Australia. We recruited people with a clinical diagnosis of symptomatic hip osteoarthritis. Participants were randomly assigned (1:1, by use of a web-based system) to aerobic physical activity and resistance exercise or resistance exercise only. Both groups received a home exercise programme and nine consultations with a physiotherapist over 3 months. The co-primary outcomes were change in hip pain severity (numerical rating scale [NRS] 0-10, with higher scores indicating worse outcomes) and function (Western Ontario and McMaster Osteoarthritis Index [WOMAC]; scale 0-68, with higher scores indicating worse outcomes) at 3 months. Analyses were done in the intention-to-treat population. People with lived experience of hip osteoarthritis were involved in the design of the study. This trial is registered with the Australian New Zealand Clinical Trial Registry (ACTRN 12619001297112), and is complete. Findings Between Oct 15, 2019, and Sept 13, 2022, 196 participants (134 [68%] women and 62 [32%] men) were randomly assigned to aerobic physical activity and resistance exercise (n=97) or resistance exercise only (n=99). At 3 months, aerobic physical activity and resistance exercise was not more effective in improving hip pain severity (mean difference 03 [95% CI-03 to 08; p=036]) or function (mean difference-09 [95% CI-36 to 18; p=051]) compared with resistance exercise alone, with both showing a mean improvement in pain (24 [SD 19] with aerobic physical activity and resistance exercise vs 22 [21] with resistance exercise only) and function (70 [104] with aerobic physical activity and resistance exercise vs 89 [108] resistance exercise only). There were 24 related adverse events with aerobic physical activity and resistance exercise, and 31 with resistance exercise only, none of which were serious. Interpretation Despite improvement in pain and function in both groups, adding moderate-intensity aerobic physical activity to resistance exercise did not lead to superior outcomes. Future work could consider higher intensity interval training before concluding no symptomatic benefit of adding aerobic exercise or physical activity to resistance exercise. Copyright (c) 2025 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND:Knee osteoarthritis (OA) is a major public health issue causing chronic pain, impaired physical function, and reduced quality of life. As there is no cure, self-management of symptoms via exercise is recommended by all current international clinical guidelines. This review updates one published in 2015. OBJECTIVES:We aimed to assess the effects of land-based exercise for people with knee osteoarthritis (OA) by comparing: 1) exercise versus attention control or placebo; 2) exercise versus no treatment, usual care, or limited education; 3) exercise added to another co-intervention versus the co-intervention alone. SEARCH METHODS:We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and two trial registries (ClinicalTrials.gov and World Health Organisation International Clinical Trials Registry Platform), together with reference lists, from the date of the last search (1st May 2013) until 4 January 2024, unrestricted by language. SELECTION CRITERIA:We included randomised controlled trials (RCTs) that evaluated exercise for knee OA versus a comparator listed above. Our outcomes of interest were pain severity, physical function, quality of life, participant-reported treatment success, adverse events, and study withdrawals. DATA COLLECTION AND ANALYSIS:We used the standard methodological procedures expected by Cochrane for systematic reviews of interventions. MAIN RESULTS:We included 139 trials (12,468 participants): 30 (3065 participants) compared exercise to attention control or placebo; 60 (4834 participants) compared exercise with usual care, no intervention or limited education; and 49 (4569 participants) evaluated exercise added to another intervention (e.g. weight loss diet, physical therapy, detailed education) versus that intervention alone. Interventions varied substantially in duration, ranging from 2 to 104 weeks. Most of the trials were at unclear or high risk of bias, in particular, performance bias (94% of trials), detection bias (94%), selective reporting bias (68%), selection bias (57%), and attrition bias (48%). Exercise versus attention control/placebo Compared with attention control/placebo, low-certainty evidence indicates exercise may result in a slight improvement in pain immediately post-intervention (mean 8.70 points better (on a scale of 0 to 100), 95% confidence interval (CI) 5.70 to 11.70; 28 studies, 2873 participants). Moderate-certainty evidence indicates exercise likely results in an improvement in physical function (mean 11.27 points better (on a scale of 0 to 100), 95% CI 7.64 to 15.09; 24 studies, 2536 participants), but little to no improvement in quality of life (mean 6.06 points better (on a scale of 0 to 100), 95% CI -0.13 to 12.26; 6 studies, 454 participants). There was moderate-certainty evidence that exercise likely increases participant-reported treatment success (risk ratio (RR) 1.46, 95% CI 1.11 to 1.92; 2 studies 364 participants), and likely does not increase study withdrawals (RR 1.08, 95% CI 0.92 to 1.26; 29 studies, 2907 participants). There was low-certainty evidence that exercise may not increase adverse events (RR 2.02, 95% CI 0.62 to 6.58; 11 studies, 1684 participants). Exercise versus no treatment/usual care/limited education Compared with no treatment/usual care/limited education, low-certainty evidence indicates exercise may result in an improvement in pain immediately post-intervention (mean 13.14 points better (on a scale of 0 to 100), 95% CI 10.36 to 15.91; 56 studies, 4184 participants). Moderate-certainty evidence indicates exercise likely results in an improvement in physical function (mean 12.53 points better (on a scale of 0 to 100), 95% CI 9.74 to 15.31; 54 studies, 4352 participants) and a slight improvement in quality of life (mean 5.37 points better (on a scale of to 100), 95% CI 3.19 to 7.54; 28 studies, 2328 participants). There was low-certainty evidence that exercise may result in no difference in participant-reported treatment success (RR 1.33, 95% CI 0.71 to 2.49; 3 studies, 405 participants). There was moderate-certainty evidence that exercise likely results in no difference in study withdrawals (RR 1.03, 95% CI 0.88 to 1.20; 53 studies, 4408 participants). There was low-certainty evidence that exercise may increase adverse events (RR 3.17, 95% CI 1.17 to 8.57; 18 studies, 1557 participants). Exercise added to another co-intervention versus the co-intervention alone Moderate-certainty evidence indicates that exercise when added to a co-intervention likely results in improvements in pain immediately post-intervention compared to the co-intervention alone (mean 10.43 points better (on a scale of 0 to 100), 95% CI 8.06 to 12.79; 47 studies, 4441 participants). It also likely results in a slight improvement in physical function (mean 9.66 points better, 95% CI 7.48 to 11.97 (on a 0 to 100 scale); 44 studies, 4381 participants) and quality of life (mean 4.22 points better (on a 0 to 100 scale), 95% CI 1.36 to 7.07; 12 studies, 1660 participants) immediately post-intervention. There was moderate-certainty evidence that exercise likely increases participant-reported treatment success (RR 1.63, 95% CI 1.18 to 2.24; 6 studies, 1139 participants), slightly reduces study withdrawals (RR 0.82, 95% CI 0.70 to 0.97; 41 studies, 3502 participants), and slightly increases adverse events (RR 1.72, 95% CI 1.07 to 2.76; 19 studies, 2187 participants). Subgroup analysis and meta-regression We did not find any differences in effects between different types of exercise, and we found no relationship between changes in pain or physical function and the total number of exercise sessions prescribed or the ratio (between exercise group and comparator) of real-time consultations with a healthcare provider. Clinical significance of the findings To determine whether the results found would make a clinically meaningful difference to someone with knee OA, we compared our results to established 'minimal important difference' (MID) scores for pain (12 points on a 0 to 100 scale), physical function (13 points), and quality of life (15 points). We found that the confidence intervals of mean differences either did not reach these thresholds or included both a clinically important and clinically unimportant improvement. AUTHORS' CONCLUSIONS:We found low- to moderate-certainty evidence that exercise probably results in an improvement in pain, physical function, and quality of life in the short-term. However, based on the thresholds for minimal important differences that we used, these benefits were of uncertain clinical importance. Participants in most trials were not blinded and were therefore aware of their treatment, and this may have contributed to reported improvements.

Introduction: We compared the 12-month effects of arthroscopic surgery and physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on the time-varying magnitude of hip contact force and muscle contributions to hip contact force during walking. Methods: Secondary analysis was performed on 37 individuals with FAI syndrome who received biomechanical assessment before and 12 months after either arthroscopic surgery (n = 17) or physiotherapist-led care (personalized hip therapy [PHT]) (n = 20). At both time points, three-dimensional whole-body motions, ground reaction forces, and surface electromyograms (n = 14) were acquired during overground walking. A neuromusculoskeletal model was used to determine hip contact force and muscle contributions to hip contact force. Two-way repeated measures analyses of variance, implemented through statistical parametric mapping, were used to assess interactions between, and main effects of, treatment (arthroscopy vs PHT) and time (baseline vs follow-up) on time-varying magnitude of hip contact force and muscle contributions to hip contact force. Effects were reported as mean differences (normalized to bodyweight, BW) with 95% confidence intervals [95% CI, lower, upper bound]. Results: For both treatment groups, hip contact force was larger at 12 months compared with their respective baseline value (mean increase across stride, arthroscopy: 0.97 BW [95% CI, 0.49-1.46] P < 0.001; PHT: 1.05 BW [95% CI, 0.68-1.43] P < 0.001); however, no interaction effects were found. For both treatment groups, hip flexor, adductor, and abductor muscle groups made greater contributions to hip contact force after 12 months compared with baseline, whereas hip extensors made smaller contributions. Conclusions: Compared with baseline, both treatments resulted in 12-month increases in hip contact force during walking caused by larger flexor, adductor, and abductor muscle forces. At 12 months, hip contact force magnitude remained different from normative values reported for healthy individuals, indicating that neither treatment fully restored hip biomechanics.

Purpose (the aim of the study): Exercise is a core recommended treatment for hip osteoarthritis (OA) symptoms. Although most evidence is based on muscle-strengthening exercise, aerobic activity has potential to enhance clinical benefits via different mechanisms. The primary aim of this study was to test the hypothesis that adding aerobic activity to a lower limb muscle strengthening exercise program leads to a significantly better reduction in hip pain and improvement in physical function than a lower-limb muscle strengthening exercise program alone, at 3 months.

Background Femoroacetabular impingement syndrome (FAIS) can cause hip pain and chondrolabral damage that may be managed non-operatively or surgically. Squatting motions require large degrees of hip flexion and underpin many daily and sporting tasks but may cause hip impingement and provoke pain. Differential effects of physiotherapist-led care and arthroscopy on biomechanics during squatting have not been examined previously. This study explored differences in 12-month changes in kinematics and moments during squatting between patients with FAIS treated with a physiotherapist-led intervention (Personalised Hip Therapy, PHT) and arthroscopy. Methods A subsample (n = 36) of participants with FAIS enrolled in a multi-centre, pragmatic, two-arm superiority randomised controlled trial underwent three-dimensional motion analysis during squatting at baseline and 12-months following random allocation to PHT (n = 17) or arthroscopy (n = 19). Changes in time-series and peak trunk, pelvis, and hip biomechanics, and squat velocity and maximum depth were explored between treatment groups. Results No significant differences in 12-month changes were detected between PHT and arthroscopy groups. Compared to baseline, the arthroscopy group squatted slower at follow-up (descent: mean difference −0.04 m∙s−1 (95%CI [−0.09 to 0.01]); ascent: −0.05 m∙s−1 [−0.11 to 0.01]%). No differences in squat depth were detected between or within groups. After adjusting for speed, trunk flexion was greater in both treatment groups at follow-up compared to baseline (descent: PHT 7.50° [−14.02 to −0.98]%; ascent: PHT 7.29° [−14.69 to 0.12]%, arthroscopy 16.32° [−32.95 to 0.30]%). Compared to baseline, both treatment groups exhibited reduced anterior pelvic tilt (descent: PHT 8.30° [0.21–16.39]%, arthroscopy −10.95° [−5.54 to 16.34]%; ascent: PHT −7.98° [−0.38 to 16.35]%, arthroscopy −10.82° [3.82–17.81]%), hip flexion (descent: PHT −11.86° [1.67–22.05]%, arthroscopy −16.78° [8.55–22.01]%; ascent: PHT −12.86° [1.30–24.42]%, arthroscopy −16.53° [6.72–26.35]%), and knee flexion (descent: PHT −6.62° [0.56– 12.67]%; ascent: PHT −8.24° [2.38–14.10]%, arthroscopy −8.00° [−0.02 to 16.03]%). Compared to baseline, the PHT group exhibited more plantarflexion during squat ascent at follow-up (−3.58° [−0.12 to 7.29]%). Compared to baseline, both groups exhibited lower external hip flexion moments at follow-up (descent: PHT −0.55 N∙m/BW∙HT[%] [0.05–1.05]%, arthroscopy −0.84 N∙m/BW∙HT[%] [0.06–1.61]%; ascent: PHT −0.464 N∙m/BW∙HT[%] [−0.002 to 0.93]%, arthroscopy −0.90 N∙m/BW∙HT[%] [0.13–1.67]%). Conclusion Exploratory data suggest at 12-months follow-up, neither PHT or hip arthroscopy are superior at eliciting changes in trunk, pelvis, or lower-limb biomechanics. Both treatments may induce changes in kinematics and moments, however the implications of these changes are unknown. Trial registration details Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015.

OBJECTIVE:We wanted to determine if higher compliance with American College of Sports Medicine (ACSM) exercise prescription guidelines influences exercise outcomes in knee osteoarthritis (OA). METHODS:We conducted a systematic review. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to January 4, 2024, for randomized controlled trials evaluating resistance and/or aerobic exercise for knee OA. Interventions were classified as higher compliance (meeting ≥60% of ACSM guideline recommendations for frequency, intensity, and duration) or lower compliance (meeting <60% of recommendations). Effects on pain and function were evaluated via meta-analysis, stratified by compliance. RESULTS:Twenty-five trials (3,290 participants) evaluated combined resistance and aerobic programs, with no differences in outcomes between those with higher and lower compliance (standardized mean difference [SMD] pain: -0.38 [95% confidence interval (CI) -0.59 to -0.17] vs -0.31 [95% CI -0.45 to -0.16], respectively; SMD function: -0.43 [95% CI -0.64 to -0.21] vs -0.36 [95% CI -0.58 to -0.14]). Sixty-six trials (5,231 participants) evaluated resistance exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.60 [95% CI -0.81 to -0.39] vs -0.93 [95% CI -1.27 to -0.59]; SMD function: -0.64 [95% CI -0.83 to -0.44] vs -0.85 [95% CI -1.20 to -0.49]). Twelve trials (958 participants) evaluated aerobic exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.79 [95% CI -1.20 to -0.38] vs -1.00 [95% CI -2.52 to 0.53]; SMD function: -0.83 [95% CI -1.27 to -0.38] vs -0.76 [95% CI -2.02 to 0.50]). CONCLUSION:Higher or lower compliance with ACSM exercise prescription guidelines did not influence exercise outcomes. Given there was substantial heterogeneity and many publications were at risk of bias, our results should be interpreted with caution.

Purpose:To assess the effect of tibial tunnel drilling technique (retro-drilled bone socket vs full tibial tunnel) on the presence and grade of postoperative, intra-articular bone debris following primary hamstring anterior cruciate ligament (ACL) reconstruction.Methods:This was a retrospective cohort study of primary hamstring autograft ACL reconstructions performed by 2 surgeons. Two blinded independent reviewers assessed the presence and length of retained intra-articular bone debris on the immediate postoperative lateral radiograph. Debris was graded according to a predefined 5-point ordinal grading system: grade 0 (no debris) to IV (severe debris). Results were analyzed according to the type of tibial tunnel; retro-drilled socket or full tibial tunnel using Kappa statistics and the Mann-Whitney U test.Results:Sixty-five patients undergoing primary hamstring ACL were included (39 tibial socket: 26 full tibial tunnel). Bone debris was observed among the tibial socket technique in 29 of 39 instances (74.3%), compared with 14 of 26 (53.8%) instances for the full tibial tunnel technique (P = .09). Where there was measurable debris present, the tibial socket group had a mean length of bone debris of 13.7 ± 6.2 mm as compared with the full tibial tunnel, 10.0 ± 4.7 mm (P = .165). There were significant differences in bone debris gradings between the 2 treatment groups, with tibial sockets having an overall greater grade (P = .04).Conclusions:A difference in the presence of, or length of, retained bone debris on the postoperative lateral radiograph was not demonstrated between the retro-drilled bone socket and full tibial tunnel techniques. However, when bone debris was present, greater grades of debris were seen in the retro-drilled socket group.Level of Evidence:III, retrospective, comparative study.