TY - JOUR
T1 - Total knee replacement and non-surgical treatment of knee osteoarthritis
T2 - 2-year outcome from two parallel randomized controlled trials
AU - Skou, Søren T
AU - Roos, Ewa M
AU - Laursen, Mogens B
AU - Rathleff, Michael S
AU - Arendt-Nielsen, Lars
AU - Rasmussen, Sten
AU - Simonsen, Ole
N1 - Copyright © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
PY - 2018/9
Y1 - 2018/9
N2 - OBJECTIVES: To compare 2-year outcomes of total knee replacement (TKR) followed by non-surgical treatment to that of non-surgical treatment alone and outcomes of the same non-surgical treatment to that of written advice.DESIGN: In two randomized trials, 200 (mean age 66) adults with moderate to severe knee osteoarthritis (OA), 100 eligible for TKR and 100 not eligible for TKR, were randomized to TKR followed by non-surgical treatment, non-surgical treatment alone, or written advice. Non-surgical treatment consisted of 12 weeks of supervised exercise, education, dietary advice, use of insoles, and pain medication. The primary outcome was the mean score of the Knee Injury and Osteoarthritis Outcome Score subscales, covering pain, symptoms, activities of daily living, and quality of life.RESULTS: Patients randomized to TKR had greater improvements than patients randomized to non-surgical treatment alone (difference of 18.3 points (95% CI; 11.3 to 25.3)), who in turn improved more than patients randomized to written advice (difference of 7.0 points (95% CI; 0.4 to 13.5)). Among patients eligible for TKR, 16 (32%) from the non-surgical group underwent TKR during 2 years and among those initially ineligible, seven patients (14%) from the non-surgical group and ten (20%) from the written advice group underwent TKR.CONCLUSIONS: 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. Two out of three patients with moderate to severe knee OA eligible for TKR delayed surgery for at least 2 years following non-surgical treatment.TRIAL REGISTRATION: ClinicalTrials.gov numbers NCT01410409 and NCT01535001.
AB - OBJECTIVES: To compare 2-year outcomes of total knee replacement (TKR) followed by non-surgical treatment to that of non-surgical treatment alone and outcomes of the same non-surgical treatment to that of written advice.DESIGN: In two randomized trials, 200 (mean age 66) adults with moderate to severe knee osteoarthritis (OA), 100 eligible for TKR and 100 not eligible for TKR, were randomized to TKR followed by non-surgical treatment, non-surgical treatment alone, or written advice. Non-surgical treatment consisted of 12 weeks of supervised exercise, education, dietary advice, use of insoles, and pain medication. The primary outcome was the mean score of the Knee Injury and Osteoarthritis Outcome Score subscales, covering pain, symptoms, activities of daily living, and quality of life.RESULTS: Patients randomized to TKR had greater improvements than patients randomized to non-surgical treatment alone (difference of 18.3 points (95% CI; 11.3 to 25.3)), who in turn improved more than patients randomized to written advice (difference of 7.0 points (95% CI; 0.4 to 13.5)). Among patients eligible for TKR, 16 (32%) from the non-surgical group underwent TKR during 2 years and among those initially ineligible, seven patients (14%) from the non-surgical group and ten (20%) from the written advice group underwent TKR.CONCLUSIONS: 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. Two out of three patients with moderate to severe knee OA eligible for TKR delayed surgery for at least 2 years following non-surgical treatment.TRIAL REGISTRATION: ClinicalTrials.gov numbers NCT01410409 and NCT01535001.
KW - Knee
KW - Knee replacement
KW - Osteoarthritis
KW - Randomized controlled trial
KW - Therapeutics
UR - http://www.scopus.com/inward/record.url?scp=85046862920&partnerID=8YFLogxK
U2 - 10.1016/j.joca.2018.04.014
DO - 10.1016/j.joca.2018.04.014
M3 - Journal article
C2 - 29723634
SN - 1063-4584
VL - 26
SP - 1170
EP - 1180
JO - Osteoarthritis and Cartilage
JF - Osteoarthritis and Cartilage
IS - 9
ER -