It’s a generally accepted “fact” that total knee arthroplasty (TKA) ranks among the most significant modern medical advancements. But the October 22, 2015 NEJM published the first rigorously controlled randomized study that “proves” that “fact” by comparing TKA to nonsurgical management.
One hundred patients with moderate-to-severe knee osteoarthritis were randomly assigned to undergo TKA followed by 12 weeks of rigorous nonsurgical treatment, or the nonsurgical treatment alone. Over a 12-month follow-up period, TKA was superior to nonsurgical treatment in terms of pain relief and functional improvement, but it was also associated with a higher number of serious adverse events, including deep-vein thrombosis and infection.
The study authors concluded that “the benefits and harms of the respective treatments underscore the importance of considering patients’ preferences and values during shared decision making about treatment for moderate-to-severe knee osteoarthritis.” JBJS Deputy Editor Jeffrey Katz, MD concurred with that conclusion in an accompanying editorial: “Treatment decisions should be shared between patients and their clinicians and anchored by the probabilities of pain relief and complications and the importance patients attach to these outcomes,” he wrote. “Each patient must weigh these considerations and make the decision that best suits his or her values.”