Total Knee Arthroplasty Superior to Non-Surgical Treatment for Pain from Knee Osteoarthritis

n = 100, Danish study; mod-to-sev knee OA eligible for unilateral TKA
Randomized to TKA followed by 12 wks non-surg tx vs non-surg tx alone (exercise, education, weight loss advice, insoles, APAP/NSAIDs).
Intent-to-treat analysis
TKA pts had greater improvement in pain, function and QOL, but also more adverse events (3 had DVT) and need for manipulation under anesthesia.
85% had >15% improvement in pain scores at 12 months vs 68% of non-surg pts.
26% of non-surgical pts elected to undergo elective TKA before 12 mo follow-up.
Conclusion:  TKA > non-surgical tx for pain relief, but it comes with more complications; also, 2/3 of non-surgical patients had significant improvement, so not unreasonable first option.
N Engl J Med 2015 Oct 22; 373:1597

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