Knee Replacement Linked To More Pain Relief, Functional Improvement and Adverse Side Effects

Søren Thorgaard Skou PT, PhD Postdoc Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark Clinical Nursing Research Unit Aalborg University Hospital

Søren Thorgaard Skou

MedicalResearch.com Interview with:
Søren Thorgaard Skou PT, PhD Postdoc
Research Unit for Musculoskeletal Function and Physiotherapy
University of Southern Denmark
Clinical Nursing Research Unit
Aalborg University Hospital 

Medical Research: What is the background for this study? What are the main findings?

Response: Total knee replacement has been performed for decades. The number of procedures are increasing and is expected to reach 1 million procedures per year in the US alone in the near future, highlighting the associated future economic burden. However, no studies have compared it to non-surgical alternatives, even though this is important to investigate its effectiveness.

We found that in patients with knee osteoarthritis eligible for total knee replacement, treatment with total knee replacement followed by non-surgical treatment (exercise, education, dietary advice, use of insoles, and pain medication) were associated with greater pain relief and functional improvement after 12 months than the non-surgical treatment alone.

However, both groups had clinically relevant improvements, and patients who underwent total knee replacement had more serious adverse events. Furthermore, most patients who were assigned to receive non-surgical treatment alone did not undergo total knee replacement within the 12 months.

Medical Research: What should clinicians and patients take away from your report?

Response: This is first high-quality study to inform the discussion between the patient and the doctor when it comes to deciding on whether or not to undergo total knee replacement. While the additional pain relief and functional improvement from total knee replacement is in favor of the surgery, several serious harms are associated with it, which is not found after non-surgical treatment. Since non-surgical treatment is also associated with clinical relevant improvements, it may be advisable to ensure that the patient has had comprehensive non-surgical treatment of sufficient dose and length before total knee replacement is considered. Either way, a process of shared decision making involving the patient’s preferences is important.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: More high-quality trials are needed to support the findings of this trial and provide further clinical insights into the effectiveness of surgical compared to non-surgical treatment of moderate to severe knee osteoarthritis. Furthermore, criteria for undergoing total knee replacement are not firm and are varying across the world. Future studies should help the clinicians decide which patients that need surgery, and which patients that need non-surgical treatment.

Citation:

A Randomized, Controlled Trial of Total Knee Replacement

Søren T. Skou, P.T., Ph.D., Ewa M. Roos, P.T., Ph.D., Mogens B. Laursen, M.D., Ph.D., Michael S. Rathleff, P.T., Ph.D., Lars Arendt-Nielsen, Ph.D., D.M.Sc., Ole Simonsen, M.D., D.M.Sc., and Sten Rasmussen, M.D., Ph.D.

N Engl J Med 2015; 373:1597-1606 October 22, 2015

DOI: 10.1056/NEJMoa1505467

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Søren Thorgaard Skou (2015). Knee Replacement Linked To More Pain Relief, Functional Improvement and Adverse Side Effects 

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