Total Knee Replacement Outperforms Nonsurgical Treatments

Total knee replacement followed by nonsurgical treatment provides better pain relief and improved function and quality of life better than nonsurgical treatment alone after 12 months among patients with knee osteoarthritis, according to the results of a new randomized, controlled trial investigating the effectiveness of total knee replacement, published in the October 22, 2015 issue of the New England Journal of Medicine. However, both groups showed clinically relevant improvements and, as might be expected, those who underwent total knee replacement had a higher number of serious adverse events._{^{"The benefits and harms of the respective treatments underscore the importance of considering patients' preferences and values during shared decision making about treatment for moderate to severe knee osteoarthritis," the researchers wrote.}}The study, which was led by Søren T. Skou, PhD, of the University of Southern Denmark, included 100 patients with moderate to severe knee osteoarthritis who were eligible for unilateral total knee replacement. Patients were randomly assigned to undergo total knee replacement followed by 12 weeks of nonsurgical treatment (total knee replacement group) or to receive only the 12 weeks of nonsurgical treatment (nonsurgical treatment group), which was delivered by physiotherapists and dietitians and consisted of exercise, education, dietary advice, use of insoles, and pain medication.[[{"type":"media","view_mode":"media_crop","fid":"44071","attributes":{"alt":"©SuphatthraChina/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_6045520780608","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4907","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©SuphatthraChina/Shutterstock.com","typeof":"foaf:Image"}}]] At 12 months follow-up, 95 patients were available for assessment. In the nonsurgical treatment group, 13 patients (26%) underwent total knee replacement before the 12-month follow-up. In the total knee replacement group, 1 patient (2%) received only nonsurgical treatment. In the intent-to-treat analysis, the total knee replacement group showed greater improvement in a quality of life score than did the nonsurgical-treatment group. The total knee replacement group also had significantly greater improvements in the scores on all five quality of life subscales, times on the timed up and go test and 20 meter walk tests, and scores on a self-reported questionnaire. However, the total knee replacement group had a higher number of serious adverse events (24) than did the nonsurgical treatment group (6). The researchers noted that most patients who were assigned to receive nonsurgical treatment alone did not undergo total knee replacement before the 12 month follow-up and still had clinically relevant improvements.  

References:

 Skou ST, et al.  

“A Randomized, Controlled Trial of Total Knee Replacement,” 

N Engl J Med 2015; 373:1597-1606

October 22, 2015

DOI: 10.1056/NEJMoa1505467