Knee osteoarthritis: surgery or not?

Dr. Andrea Bannert has been with since 2013. The doctor of biology and medicine editor initially carried out research in microbiology and is the team's expert on the tiny things: bacteria, viruses, molecules and genes. She also works as a freelancer for Bayerischer Rundfunk and various science magazines and writes fantasy novels and children's stories.

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Knee joint pain can make everyday life difficult: getting up hurts, stairs become an apparently insurmountable obstacle. To escape the pain, 158,000 Germans with osteoarthritis have an artificial knee inserted every year. But the usefulness of this operation is still controversial. Danish researchers have now examined the pros and cons in a high-quality comparative study.

For their study, the researchers led by Søren Skou from the University of Southern Denmark in Odense divided 100 patients with severe osteoarthritis of the knee into two groups: group one received an artificial knee replacement and then rehabilitation training for twelve weeks, group two received only conservative therapy. This included professionally guided exercises twice a week, a weight loss program, individually adapted insoles and pain relievers.

20-meter walk test

The researchers then evaluated whether the operation is better able to relieve pain and increase the resilience of the knee than conservative treatment alone. After twelve months, it was measured how severe the pain the patients were and how their everyday activities and thus the quality of life had improved compared to the state before the treatment. To do this, the researchers evaluated questionnaires on the one hand, and carried out various tests on the patients on the other hand, such as how long it took for a patient to get up and walk three meters or how he performed in a special walking test.

The result: Overall, the operated patients performed better than those treated conservatively. On a 100-point scale, well-being and resilience improved by an average of 32.5 points, in group two it was only 16 points. Overall, the operation with subsequent training led to a significant improvement in the clinical picture in 85 percent of the patients, while 68 percent benefited from the purely conservative treatment.

Sensible therapy

But even if the study seems to speak in favor of knee replacement, one must carefully weigh the pros and cons of the procedure in each individual case, says Søren. Because, for example, surgery has significantly more side effects than conservative therapy. Three of the operated patients developed a leg vein thrombosis, in three others the knee became stiff, and one patient contracted a wound infection. A total of 24 adverse events were registered in the surgical group, compared with only six in the conservatively treated group.

All in all, the research results show above all that something can be done against knee pain and that treatment - whether OP or conservative - makes sense in any case, according to the scientists.

Source: Søren T. Skou, A Randomized, Controlled Trial of Total Knee Replacement, N Engl J Med 2015; 373: 1597-1606, October 22, 2015DOI: 10.1056 / NEJMoa1505467

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