The authors included one hundred patients from a Danish hospital with a diagnosis of moderate-to-severe knee OA as diagnosed by radiography, who were eligible for TKR. Patients were randomly allocated to either the surgical (n = 50) or the non-surgical group (n = 50).
Those who underwent TKR all received a similar prothesis, placed by the same orthopaedic surgeon. The patientts in the non-surgical group received sixty-minute sessions supervised by a physiotherapist twice a week; during these sessions the NeuroMuscular Exercise (NEMEX) programme was applied. After twelve weeks they were transitioned to an eight-week programme with home exercises. They were also given education on disease characteristics, dietary advice for a healthy weight, insoles and ibuprofen pain medication. Patients who underwent a TKR first received the same non-surgical management.
The costs of both groups were retrieved from the Danish national registry, and monitored for up to 24 months for additional input and costs. Cost-effectivenss was expressed in quality-adjusted life years (QALYs). Health-related quality of life was measured using the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D).
At 12 months, the costs in the TKR plus non-surgical treatment group were more than double of those in the non-surgical group.
However, 24 months the costs of the TKR plus non-surgical treatment were not significantly different from the non-surgical group. This is due to several of the patients in the non-surgical group who underwent TKR at a later time - 1 in 3 in the non-surgical group went on to have a TKR in the next two years.
Although TKR plus non-surgical treatment seemed to be more effective, it was not more cost-effective than non-surgical treatment with the option of surgery at a later time.
Finally, as results were sensitive for adjustment for covariates and imputation of missing values, more research with longer periods of follow-up is necessary.
> From: Skou et al., BMJ Open 10 (2020) e033495 . All rights reserved to The Author(s). Click here for the online summary.
