Confirming the Value of Total Knee Replacement
SOURCE: Skou ST, et al. A randomized, controlled trial of total knee replacement. N Eng J Med 2015;373:1597-1606.
Since more than 500,000 total knee replacements are performed annually in the United States, it is heartening to review a clinical trial confirming efficacy. After all, it was not so long ago that a clinical trial of knee lavage — an equally well-respected, time-honored, and commonplace orthopedic intervention — failed to show benefit when compared to sham lavage in patients with knee pain and osteoarthritis.
This prospective, controlled trial included 95 patients who were randomized to medical treatment (physical therapy, analgesia, and anti-inflammatory agents) or total knee replacement, which was also followed by medical therapy. Outcomes were measured at 12 months. As measured by the Knee Injury and Osteoarthritis Outcome Score, total knee replacement patients enjoyed significantly greater improvements than medical therapy, although both groups did improve significantly over 12 months. Additionally, because of symptom progression, 26% of subjects originally assigned to medical therapy ultimately underwent surgical intervention during the 12-month interval.
Total knee replacement provides better outcomes for pain, symptoms, activities of daily living, and quality of life than medical therapy alone.
Total knee replacement provides better outcomes for pain, symptoms, activities of daily living, and quality of life than medical therapy alone.
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