Total Knee Replacement compared to Physical Therapy for Knee Arthritis
Knee osteoarthritis (OA) is a common condition in middle to older age and is a leading cause of pain and disability among this population. Our prior posts detailed improvements in cartilage thickness occurring in individuals with mild knee OA after a lower body exercise program. In advanced stages of knee OA or with a progressive worsening of symptoms and loss of function patients may opt for total knee replacement surgery. This is a relatively common and effective surgery for knee OA. Authors reported 670,000 patients in the U.S. underwent a total knee replacement (TKA) in 2012 alone. These surgeries amounted to a total cost of $36 billion dollars and this cost is estimated to rise with our aging population (Kurtz et al. 2007).
A recent well designed study in the New England Journal of Medicine examined the short and long term outcomes associated with either a 12 week pre operative Physical Therapy and TKA compared with a similar Physical Therapy program and other conservative treatments (Skou et al. 2015). 100 patients with moderate to severe OA participated in the study and were randomly assigned to 1 of 2 groups listed above. The authors noted significant improvements in function in both groups over the following 12 months. In the Physical Therapy group, 74% of the patients reported enough improvements to not opt for any surgical intervention over the course of the study. As a group, the TKA group did report higher outcomes at 12 months compared to the Physical Therapy and conservative group. Pre operative Physical Therapy has been shown to accelerate recovery and lead to greater improvements in surgical outcomes compared to groups offered surgery alone (Villadsen et al. 2014) Due to the invasive nature of the surgery, surgical patients had a 4 times greater risk of adverse events compared to the conservative group.
In short, Conservative treatment of knee OA has been shown to delay or prevent the need for TKA surgery but some patients may require the procedure. Patients considering this surgery should opt for pre operative Physical Therapy to accelerate outcomes and improve functional outcomes at short and long term follow ups.