Skou TKR vs non-surgical RCT

A Randomized, Controlled Trial of Total Knee Replacement.

Skou ST, Roos EM, Laursen MB, et al. The New England journal of medicine 2015 · PMID 26488691 · doi:10.1056/nejmoa1505467

Question

Does total knee replacement plus non-surgical treatment give better outcomes than non-surgical treatment alone in moderate to severe knee OA?

Design

Danish RCT with 12-month follow-up.

Patients

Patients with moderate to severe knee osteoarthritis eligible for unilateral TKR.

Intervention

TKR followed by a 12-week structured non-surgical programme

Comparison

12-week non-surgical programme alone (exercise, education, diet, insoles, analgesia)

Primary outcome

KOOS4 at 12 months

Key result

TKR plus non-surgical treatment produced significantly greater improvement in pain, function and quality of life at 12 months, but with more serious adverse events; most in the non-surgical group improved and many had not undergone TKR by 1 year.

Limitations

Unblinded with a modest sample size and short follow-up; crossover to surgery in the non-surgical arm.

Impact on practice

First RCT confirming TKR is more effective than structured non-operative care, while showing a structured programme is a reasonable first step for many patients.