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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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A Randomized, Controlled Trial of Total Knee Replacement.

Søren T Skou1, Ewa M Roos, Mogens B Laursen

  • 1From the Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (S.T.S., E.M.R.), Clinical Nursing Research Unit (S.T.S.) and Orthopedic Surgery Research Unit (S.T.S., M.B.L., O.S., S.R.), Aalborg University Hospital, and Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine (S.T.S., M.B.L., M.S.R., L.A.-N., O.S., S.R.), and Department of Clinical Medicine (M.B.L., O.S., S.R.), Aalborg University, Aalborg - all in Denmark.

The New England Journal of Medicine
|October 22, 2015
PubMed
Summary

Total knee replacement surgery improved pain and function for knee osteoarthritis patients compared to nonsurgical treatment. However, surgery led to more serious adverse events and most patients did not opt for surgery when offered nonsurgical care first.

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Area of Science:

  • Orthopedic surgery
  • Rheumatology
  • Clinical trial methodology

Background:

  • High volume of total knee replacements annually in the US.
  • Lack of high-quality evidence comparing surgical vs. nonsurgical interventions for knee osteoarthritis.
  • Need for comparative effectiveness research in joint replacement procedures.

Purpose of the Study:

  • To compare the effectiveness of total knee replacement followed by nonsurgical treatment versus nonsurgical treatment alone for knee osteoarthritis.
  • To evaluate pain relief and functional improvement in patients eligible for knee replacement.
  • To assess the safety and adverse events associated with each treatment approach.

Main Methods:

  • Randomized controlled trial with 100 patients diagnosed with moderate-to-severe knee osteoarthritis.
  • Two arms: total knee replacement followed by 12 weeks of nonsurgical treatment vs. 12 weeks of nonsurgical treatment alone.
  • Primary outcome: change in Knee Injury and Osteoarthritis Outcome Score (KOOS4) at 12 months.

Main Results:

  • Total knee replacement group showed significantly greater improvement in KOOS4 scores (32.5) compared to the nonsurgical group (16.0).
  • Higher incidence of serious adverse events in the total knee replacement group (24 vs. 6).
  • Only 26% of patients in the nonsurgical group underwent total knee replacement before 12 months.

Conclusions:

  • Total knee replacement followed by nonsurgical treatment offers superior pain relief and functional improvement for knee osteoarthritis patients.
  • Total knee replacement is associated with increased serious adverse events compared to nonsurgical management.
  • Nonsurgical treatment alone is a viable option for many patients, with a low rate of subsequent surgery.