TY - JOUR
T1 - Five-year follow-up of patients with knee osteoarthritis not eligible for total knee replacement
T2 - results from a randomised trial
AU - Larsen, Jesper Bie
AU - Roos, Ewa
AU - Laursen, Mogens
AU - Holden, Sinead
AU - Johansen, Martin Nygaard
AU - Rathleff, Michael Skovdal
AU - Arendt-Nielsen, Lars
AU - Rasmussen, Sten
AU - Skou, Søren T
N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/11/25
Y1 - 2022/11/25
N2 - OBJECTIVES: The main objective was to investigate 5-year outcomes in patients with knee osteoarthritis, randomised to one of two non-surgical treatments.SETTING: Two outpatient clinics.PARTICIPANTS: At baseline, 100 patients with radiographic and symptomatic knee osteoarthritis not found eligible for knee replacement (KR) were included. Main exclusion criteria were average score above 75 of the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, function of daily living and quality of life; KOOS4 and average knee pain the previous week greater than 60 mm on a 100 mm visual analogue scale.INTERVENTIONS: Patients were randomised to supervised non-surgical treatment consisting of patient education, supervised exercise, weight loss, insoles, and pain medication (the MEDIC treatment) or written advice. The 12-week MEDIC treatment included patient education, neuromuscular exercise, insoles and a dietary weight loss programme and/or pain medication if needed and written advice consisted of two leaflets.PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was 5-year mean change for KOOS4. Secondary outcomes included KOOS subscales, self-reported health, usage of pain medication and self-reported physical activity.RESULTS: Thirty-nine (78%) and 36 (72%) from the MEDIC and written advice groups responded at 5 years. There were no between-group differences in KOOS4 (difference 5.3 (95% CI -1.5 to 12.1) or any secondary outcomes. However, the 95% CI included the minimal clinically important difference for the main outcome.Seventy-six percent of the MEDIC group and 66% of the written advice group experienced clinically important improvements in KOOS4.Fifteen patients (30%) from the MEDIC group and 17 (34%) from the written advice group received KR in the index knee. Undergoing KR did not result in a statistically significant greater improvement in KOOS4 (difference 6.1 (95% CI -1.1 to 13.4).CONCLUSIONS: No statistically significant differences between supervised non-surgical treatment and written advice were demonstrated at 5 years. Most patients experienced clinically important improvements, irrespective of initial treatment strategy or KR.TRIAL REGISTRATION NUMBER: NCT01535001; ClinicalTrials.gov.
AB - OBJECTIVES: The main objective was to investigate 5-year outcomes in patients with knee osteoarthritis, randomised to one of two non-surgical treatments.SETTING: Two outpatient clinics.PARTICIPANTS: At baseline, 100 patients with radiographic and symptomatic knee osteoarthritis not found eligible for knee replacement (KR) were included. Main exclusion criteria were average score above 75 of the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, function of daily living and quality of life; KOOS4 and average knee pain the previous week greater than 60 mm on a 100 mm visual analogue scale.INTERVENTIONS: Patients were randomised to supervised non-surgical treatment consisting of patient education, supervised exercise, weight loss, insoles, and pain medication (the MEDIC treatment) or written advice. The 12-week MEDIC treatment included patient education, neuromuscular exercise, insoles and a dietary weight loss programme and/or pain medication if needed and written advice consisted of two leaflets.PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was 5-year mean change for KOOS4. Secondary outcomes included KOOS subscales, self-reported health, usage of pain medication and self-reported physical activity.RESULTS: Thirty-nine (78%) and 36 (72%) from the MEDIC and written advice groups responded at 5 years. There were no between-group differences in KOOS4 (difference 5.3 (95% CI -1.5 to 12.1) or any secondary outcomes. However, the 95% CI included the minimal clinically important difference for the main outcome.Seventy-six percent of the MEDIC group and 66% of the written advice group experienced clinically important improvements in KOOS4.Fifteen patients (30%) from the MEDIC group and 17 (34%) from the written advice group received KR in the index knee. Undergoing KR did not result in a statistically significant greater improvement in KOOS4 (difference 6.1 (95% CI -1.1 to 13.4).CONCLUSIONS: No statistically significant differences between supervised non-surgical treatment and written advice were demonstrated at 5 years. Most patients experienced clinically important improvements, irrespective of initial treatment strategy or KR.TRIAL REGISTRATION NUMBER: NCT01535001; ClinicalTrials.gov.
KW - Arthroplasty, Replacement, Knee
KW - Follow-Up Studies
KW - Humans
KW - Osteoarthritis, Knee/surgery
KW - Pain/surgery
KW - Quality of Life
KW - Knee
KW - Musculoskeletal disorders
KW - RHEUMATOLOGY
KW - REHABILITATION MEDICINE
KW - Orthopaedic & trauma surgery
UR - http://www.scopus.com/inward/record.url?scp=85142940325&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-060169
DO - 10.1136/bmjopen-2021-060169
M3 - Journal article
C2 - 36428014
SN - 2044-6055
VL - 12
SP - e060169
JO - BMJ Open
JF - BMJ Open
IS - 11
M1 - e060169
ER -