Total knee replacement can usually relieve pain and improve function, but a nonsurgical regimen can also be effective in some people without posing the complication risks that can plague people who choose surgery, according to a new study reviewed in Reuters Health. The test found that while 85 percent of patients who underwent surgery showed clinically-significant improvement after one year, so did 67 percent assigned to a combination of supervised exercise, use of insoles, pain medication, education and dietary advice.
There’s little debate that knee replacement helps many people, and the new test of 100 patients – the first randomized controlled trial ever done on the technique – confirms it. Surgery patients didn’t show just some improvement. They registered far less pain and disability than those assigned to the non-surgery group.
Yet the study was needed because as many as 1 percent of surgery patients die within 90 days of their operation and about 1 in 5 have residual pain at least six months after the procedure, said Dr. Jeffrey Katz of Harvard Medical School in Cambridge, Massachusetts, in an accompanying editorial in the New England Journal of Medicine. “Until now, we have lacked rigorously controlled comparisons between total knee replacement and its alternatives.”
“People need to understand and respect that knee replacement is not without complication. Knee replacement is a big surgical procedure and there are risks associated with it,” Dr. Andrew Pollak, chairman of orthopedics at the University of Maryland School of Medicine in Baltimore, told Reuters Health. The study “really emphasizes what we suspected all along – total knee replacement works. It will be obvious to many of us who take care of patients. But for patients with significant symptoms and evidence of arthritis, total knee replacement is a very effective way of improving quality of life,” said Pollak, who was not associated with the research. “Therapy alone has a role. It does help certain patients. It can certainly prolong the time to when knee replacement is necessary.”
More than 670,000 total knee replacements are done in the U.S. each year at a cost of $36.1 billion.