medwireNews: Follow-up results from a randomized trial demonstrate that the addition of total knee replacement (TKR) to nonsurgical treatment leads to greater improvements in pain and function among patients with osteoarthritis (OA).
As reported in Osteoarthritis and Cartilage, the researchers analyzed 2-year outcomes from a trial in which OA patients who were eligible for surgery were randomly assigned to undergo TKR followed by 12 weeks of supervised nonsurgical treatment consisting of exercise, education, dietary advice, insole use, and pain medication, or to receive nonsurgical treatment alone.
In accordance with the previously reported results from the 1-year follow-up, Søren Skou (University of Southern Denmark, Odense) and co-investigators found that the 43 patients in the TKR group experienced a significantly greater improvement in the mean score on four Knee Injury and Osteoarthritis Outcome Score subscales (KOOS4) – covering pain, symptoms, activities of daily living, and quality of life – over 2 years than the 47 participants given only nonsurgical treatment.
The KOOS4 score improved by an average of 34.6 points from baseline to the 2-year follow-up in the TKR group, and by 16.1 points in the nonsurgical group, giving an adjusted between-group difference of 18.3 points.
In order for one patient to experience a clinically relevant improvement, defined as a 15% improvement in KOOS4 score, between four and five patients would need to have TKR in addition to nonsurgical treatment, explain the researchers.
Skou and team also evaluated the 2-year follow-up results from another randomized trial of OA patients who were not eligible for TKR, which compared the same supervised nonsurgical intervention with written advice comprising information leaflets on OA symptoms, treatment, and healthy lifestyle.
Patients receiving the nonsurgical intervention experienced an average 18.5-point improvement in KOOS4 score from baseline to the 2-year follow-up, compared with an average improvement of 11.6 points in the written advice group, translating into a significant adjusted between-group difference of 7.0 points.
Together, these findings suggest that “TKR followed by non-surgical treatment is more effective on pain and function than non-surgical treatment alone, which in turn is more effective than written advice,” write the researchers.
However, they note that these improvements may occur at the cost of a greater risk for knee-related serious adverse events with TKR, as demonstrated in previously published studies.
The study authors conclude that their results support current treatment guidelines for knee OA, which suggest “a stepwise approach starting with patient education, exercise and weight loss if needed, progressing to additional treatment such as analgesics and finally surgery if sufficient pain relief and functional improvement is not achieved to balance treatment effects and the potential for harms.”
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