Knee replacement surgery is often the treatment of choice for advanced osteoarthritis, but is it the best treatment option available?
A study published last month in The New England Journal of Medicine evaluated the effectiveness of knee replacement surgery combined with non-surgical treatment (physical activity, dietary tips, biomechanical measures, drug therapy, etc.) compared to only non-surgical treatments. In the study of 100 adults with moderate to severe osteoarthritis, 50 were chosen to receive knee replacements followed by non-surgical therapy. The other half of the group received only non-surgical treatments, including exercises and supervised weight loss.
After a period of one year, 85 percent of the patients who underwent total knee replacement and non-surgical treatment showed more improvement in terms of pain scores, daily activities and overall quality of life compared to 68 percent patients who only received non-surgical treatments.
However, the study also revealed that patients who underwent surgery had more complications, such as severe deep vein clots, fractures and serious infection. While surgical treatment can provide the greatest pain relief and improvement in function, non-surgical treatments carry the potential for fewer adverse side effects.
“Surgery is much better at improving pain than physical therapy,” said Dr. Jeffrey N. Katz, director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston, in an editorial accompanying the new report. “But at the same time, it’s a little bit surprising that this physical-therapy regimen was associated with substantial pain relief.”
Although hundreds of thousands of knee replacements are performed every year in the United States, this study is surprisingly the first controlled trial to compare knee replacement surgery to non-surgical approaches to knee pain. Surgeons have generally assumed that total knee replacement surgery provides the best results, but this study suggests that surgery is not always the best option for patients with severe osteoarthritis.
If you are facing a decision about knee surgery, talk to your doctor about your specific risks for complications. Non-surgical treatments are effective for some patients, and may be the better option if your risk of complications is high.
