Article, 2024

Total Knee Arthroplasty Versus Education and Exercise for Knee Osteoarthritis: A Propensity‐Matched Analysis

Arthritis Care & Research, ISSN 2151-464X, 2151-4658, Volume 76, 5, Pages 682-690, 10.1002/acr.25293

Contributors

Young, James Justin 0000-0003-1210-3106 (Corresponding author) [1] [2] Zywiel, Michael George [1] Skou, Søren Thorgaard 0000-0003-4336-7059 [2] [3] Chandran, Vinod 0000-0002-8297-0275 [1] Davey, J Rod [1] Gandhi, Rajiv [1] Mahomed, Nizar Noorallah 0000-0002-6907-1750 [1] Syed, Khalid Ali [1] Veillette, Christian J H [1] Rampersaud, Yoga Raja [1] Perruccio, Anthony V 0000-0002-4389-0993 [1]

Affiliations

  1. [1] University Health Network
    2. [NORA names: Canada; America, North; OECD];
  2. [2] University of Southern Denmark
    3. [NORA names: SDU University of Southern Denmark; University; Denmark; Europe, EU; Nordic; OECD];
  3. [3] University of Southern Denmark, Odense, Denmark, and Næstved‐Slagelse‐Ringsted Hospitals, Slagelse, Denmark
    4. [NORA names: Denmark; Europe, EU; Nordic; OECD]

Abstract

OBJECTIVE: We estimate the treatment effect of total knee arthroplasty (TKA) versus an education and exercise (Edu+Ex) program on pain, function, and quality of life outcomes 3 and 12 months after treatment initiation for knee osteoarthritis (OA). METHODS: Patients with knee OA who had undergone TKA were matched on a 1:1 ratio with participants in an Edu+Ex program based on a propensity score fitted to a range of pretreatment covariates. After matching, between-group differences in improvement (the treatment effect) in Knee Injury and Osteoarthritis Outcome Score 12-item version (0, worst to 100, best) pain, function, and quality of life from baseline to 3 and 12 months were estimated using linear mixed models, adjusting for unbalanced covariates, if any, after matching. RESULTS: The matched sample consisted of 522 patients (Edu+Ex, n = 261; TKA, n = 261) who were balanced on all pretreatment characteristics. At 12-month follow-up, TKA resulted in significantly greater improvements in pain (mean difference [MD] 22.8; 95% confidence interval [95% CI] 19.7-25.8), function (MD 21.2; 95% CI 17.7-24.4), and quality of life (MD 18.3; 15.0-21.6). Even so, at least one-third of patients receiving Edu+Ex had a clinically meaningful improvement in outcomes at 12 months compared with 75% of patients with TKA. CONCLUSION: TKA is associated with greater improvements in pain, function, and quality of life, but these findings also suggest that Edu+Ex may be a viable alternative to TKA in a meaningful proportion of patients, which may reduce overall TKA need. Confirmatory trials are needed.

Keywords

analysis, arthroplasty, associated with greater improvement, baseline, baseline to 3, between-group differences, characteristics, clinic, clinically meaningful improvements, confirmatory trials, covariates, differences, education, effect, exercise, findings, follow-up, function, greater improvement, improvement, initiation, injury, knee, knee OA, knee arthroplasty, knee injuries, knee osteoarthritis, life, linear mixed models, matching, meaningful improvements, mixed models, model, months, needs, osteoarthritis, outcomes, outcomes 3, pain, participants, patients, pretreatment, pretreatment characteristics, pretreatment covariates, program, propensity, propensity score, propensity-matched analysis, proportion, proportion of patients, quality, quality of life, ratio, samples, scores, total, total knee arthroplasty, treatment, treatment effects, treatment initiation, trials, version

Funders

  • European Research Council
  • Arthritis Society
  • European Commission

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