2018, Volume 4 Issue 3
Comparative study of total knee replacement Vs non surgical treatment regarding management of knee osteoarthritis
Author(s): Dr. Khaja Adil Ahmed and Dr. Mir Zia Ur Rahman Ali
Abstract: Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. Osteoarthritis (OA) is a common disease of aged population and one of the leading causes of disability. Incidence of knee OA is rising by increasing average age of general population. Age, weight, trauma to joint due to repetiting movements in particular squatting and kneeling are common risk factors of knee OA. Several factors including cytokines, leptin, and mechanical forces are pathogenic factors of knee OA. Treatment options for osteoarthritis typically depend on the severity of the condition and the particular joints involved. They most often include medication Physical activity, stretching, and weight management, physical and occupational therapy, with or without assistive devices and surgery. The most common surgeries to treat knee arthritis are total knee replacement (total knee arthroplasty), partial knee replacement (unicompartmental knee arthroplasty), knee osteotomy (tibial osteotomy or femoral osteotomy), knee arthroscopy and cartilage repair and restoration. In this randomized, controlled trial, we enrolled 90 patients with moderate-to severe knee osteoarthritis who were eligible for unilateral total knee replacement. Patients were randomly assigned to undergo total knee replacement followed by 10 weeks of nonsurgical treatment (total-knee-replacement group) or to receive only the 10 weeks of nonsurgical treatment (nonsurgical-treatment group), which was delivered by physiotherapists and dietitians and consisted of exercise, education, dietary advice, use of insoles, and pain medication. The primary outcome was the change from baseline to 10 months in the mean score on four Knee Injury and Osteoarthritis Outcome Score subscales, covering pain, symptoms, activities of daily living, and quality of life (KOOS4); scores range from 0 (worst) to 100 (best). A total of 80 patients completed the 10-month follow-up assessment. In the nonsurgical-treatment group, 11 patients underwent total knee replacement before the 10-month follow-up; in the total-knee-replacement group, 1 patient received only nonsurgical treatment. In the intention-to-treat analysis, the total-kneereplacement group had greater improvement in the KOOS4 score than did the nonsurgical- treatment group. The total-knee-replacement group had a higher number of serious adverse events than did the nonsurgical-treatment group. In patients with knee osteoarthritis who were eligible for unilateral total knee replacement, treatment with total knee replacement followed by nonsurgical treatment resulted in greater pain relief and functional improvement after 10 months than did nonsurgical treatment alone. However, total knee replacement was associated with a higher number of serious adverse events than was nonsurgical treatment, and most patients who were assigned to receive nonsurgical treatment alone did not undergo total knee replacement before the 10-month follow-up.
