A new study found that knee replacement surgery is the best option for addressing pain of patients with arthritis; however, it entails more risks.
"Total knee replacement is considered to be an effective treatment for end-stage knee osteoarthritis," the authors wrote. "The number of total knee replacements is expected to increase as the average age of the population increases, which highlights the associated future economic burden."
Despite the numerous procedures performed every year, the researchers of the current study wrote that they are not aware of existing high-quality randomized, controlled research that compared surgical and nonsurgical treatment for osteoarthritis.
Based on available data, standards of clinical management include a core treatment that is comprised of physical activity, education, dietary tips and biomechanical measures such as the use of insoles and drug therapy.
The authors of the current study performed their investigation by including 100 patients diagnosed with knee osteoarthritis, who were qualified for unilateral total knee replacement. The eligibility of the patients were determined by one of nine orthopedic surgeons at one of two specialized clinics in Denmark.
The goal of the study, which was conducted from Sept. 12, 2011 to Dec. 6, 2013, is to determine if the said operation followed by weeks of nonsurgical interventions as stated in clinical guidelines may give higher pain relief, enhance function and quality of life compared to nonsurgical treatment alone.
The participants were randomly assigned to either have a total knee replacement surgery followed by a 12-week nonsurgical treatment or receive nonsurgical interventions only.
After a period of one year, the group who underwent total knee replacement and nonsurgical treatment showed an improvement that is twice as much as the others in terms of pain scores, daily activities and overall quality of life.
About two-thirds of those who did not receive surgery still exuded significant improvement but one-fourth of this group necessitated surgery within the year.
Complications, however, were more noted in the surgery group. Severe deep vein clots, fracture and serious infection were some of the negative outcomes associated with surgery.
In a commentary written by Dr. Jeffrey Katz, a joint specialist at Brigham and Women's Hospital in Boston, he said that other researches demonstrate that surgical procedure is not entirely successful all the time and that about one in five patients experience some pain until six month postoperatively.
In the end, the authors concluded that total knee replacement together with nonsurgical treatment is better than nonsurgical therapy alone, in terms of giving pain relief and boosting function. However, they said that surgery is more associated with serious adverse effects and most participants who did not receive surgery did not require total knee replacement within the year but still significantly improved.
The study was published in the New England Journal of Medicine on Thursday, Oct. 22.
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