Knee replacement: surgical procedures and outcomes

Article Summary: A Randomized, Controlled Trial of Total Knee Replacement
In this study, the authors conduct an assessment of two approaches for addressing moderate-to-severe knee osteoarthritis. The said approaches are; total knee replacement followed by a nonsurgical program, and the adoption of nonsurgical interventions. It is, however, important to note that as the authors point out, both approaches lead to improvements that are deemed clinically relevant. More specifically, the authors of this particular study present their findings on the efficacy rate of the fusion of both surgical treatment and nonsurgical treatment, with the nonsurgical treatment program coming after the surgical intervention. The nonsurgical treatment program was implemented for a total of 12 weeks and it included pain medications, utilization of insoles, advice on diet, education, and exercise. The patient I took care of during my clinical rotation has knee pain and is scheduled for total knee replacement. On the strength of the findings of this particular study, I would recommend that she proceeds with this surgical intervention.
From the onset, the authors of this particular article point out that “total knee replacement is considered to be an effective treatment for end-knee osteoarthritis.” It is perhaps for this reason that there has been a significant increase in the number of persons seeking total knee replacements in the U.S. The present study comes to the conclusion that “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 12 months than did nonsurgical treatment alone.”
For these results to ring true for my patient, the surgical operation as well as the nonsurgical treatment plan ought to follow the same standard as that of the study highlighted herein. If this were to happen, my patient would likely experience significant improvements in the quality of life, functionality, as well as greater pain relief after she undergoes the total knee replacement and follows this up with the appropriate nonsurgical approaches. The patient would also have to contend with the possibility of adverse events following surgery. It should also be noted that as per the study findings, “total knee replacement was associated with, a higher number of serious adverse events than was nonsurgical treatment…” Towards this end, the adverse events my patient would expect include stiffness calling for brisement force, and deep venous thrombosis. The said events would largely be confined to the patient’s index knee.
It is important to note that as the authors of this particular article observe, the increase in the population’s average age is likely to result in an increase in the number of total knee replacements performed. This will effectively add to the nation’s economic burden. It is for this reason that there is need for more studies that assess how effective total knee replacements are in comparison to treatment options that are nonsurgical in nature. These would come in handy in seeking to justify or demerit the continued adoption of surgical interventions. As a matter of fact, it should be noted that the authors too call for additional research undertakings to assess how effective total knee replacements are. This is more so the case given that as they further point out, it is possible that there are no “ongoing randomized trials investigating the effectiveness of total knee replacement, despite its wide and increasing use.”
References
Skou, S.T., Roos, E.M., Laursen, M.B., Rathleff, M.S., Nielsen, L.A., Simonsen, O. & Rasmussen, S. (2015). A Randomized, Controlled Trial of Total Knee Replacement. The New England Journal of Medicine, 373(17), 1597 – 1606.