Abstract

Objectives

The main objective was to investigate 5-year outcomes in patients with knee osteoarthritis, randomised to one of two non-surgical treatments.

Setting

Two outpatient clinics.

Participants

At baseline, 100 patients with radiographic and symptomatic knee osteoarthritis not found eligible for knee replacement (KR) were included. Main exclusion criteria were average score above 75 of the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, function of daily living and quality of life; KOOS4 and average knee pain the previous week greater than 60 mm on a 100 mm visual analogue scale.

Interventions

Patients were randomised to supervised non-surgical treatment consisting of patient education, supervised exercise, weight loss, insoles, and pain medication (the MEDIC treatment) or written advice. The 12-week MEDIC treatment included patient education, neuromuscular exercise, insoles and a dietary weight loss programme and/or pain medication if needed and written advice consisted of two leaflets.

Primary and secondary outcome measures

Primary outcome was 5-year mean change for KOOS4. Secondary outcomes included KOOS subscales, self-reported health, usage of pain medication and self-reported physical activity.

Results

Thirty-nine (78%) and 36 (72%) from the MEDIC and written advice groups responded at 5 years. There were no between-group differences in KOOS4 (difference 5.3 (95% CI −1.5 to 12.1) or any secondary outcomes. However, the 95% CI included the minimal clinically important difference for the main outcome.

Seventy-six percent of the MEDIC group and 66% of the written advice group experienced clinically important improvements in KOOS4.

Fifteen patients (30%) from the MEDIC group and 17 (34%) from the written advice group received KR in the index knee. Undergoing KR did not result in a statistically significant greater improvement in KOOS4 (difference 6.1 (95% CI −1.1 to 13.4).

Conclusions

No statistically significant differences between supervised non-surgical treatment and written advice were demonstrated at 5 years. Most patients experienced clinically important improvements, irrespective of initial treatment strategy or KR.

Trial registration number

NCT01535001; ClinicalTrials.gov.

Details

Title
Five-year follow-up of patients with knee osteoarthritis not eligible for total knee replacement: results from a randomised trial
Author
Jesper Bie Larsen 1   VIAFID ORCID Logo  ; Roos, Ewa 2   VIAFID ORCID Logo  ; Laursen, Mogens 3 ; Holden, Sinead 4   VIAFID ORCID Logo  ; Martin Nygaard Johansen 5   VIAFID ORCID Logo  ; Rathleff, Michael Skovdal 4 ; Arendt-Nielsen, Lars 6 ; Rasmussen, Sten 7   VIAFID ORCID Logo  ; Skou, Søren T 8   VIAFID ORCID Logo 

1  Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark 
2  Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark 
3  Orthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark 
4  Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark 
5  Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark 
6  Translational Pain Biomarker, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark 
7  Orthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark 
8  Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Orthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark 
First page
e060169
Section
Rehabilitation medicine
Publication year
2022
Publication date
2022
Publisher
BMJ Publishing Group LTD
e-ISSN
20446055
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1136/bmjopen-2021-060169
ProQuest document ID
2740161161
Copyright
© 2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.