Prior surgery has no impact on exercise therapy, education outcomes in knee osteoarthritis
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Key takeaways:
- Improvements in knee OA were similar in an education and exercise program regardless of previous knee surgery.
- Patients with prior surgery can ‘expect an average outcome.’
Patients with knee osteoarthritis in a supervised education and exercise program demonstrated similar clinical outcomes regardless of whether they previously had knee surgery, according to data published in Clinical Rheumatology.
“Previous knee surgery is a major risk factor for knee osteoarthritis, and this group of patients may represent a distinct subgroup of knee OA patients,” Dorte T. Grønne, a PhD student at the University of Southern Denmark, and colleagues wrote. “Even years after surgery, there may still be deficits in muscle strength, which is associated with impaired knee function and lower limb proprioception as well as knee OA.
“International guidelines recommend a multimodal, individualized non-surgical treatment approach as the first-line treatment for patients with knee OA,” they added. “Yet, it is currently unclear if the outcome after patient education and supervised exercise treatment differs for patients previously having had knee surgery compared to patients without previous surgery.”
To compare education and exercise therapy outcomes between these two groups, Grønne and colleagues conducted a cohort study using data from the Good Life with Osteoarthritis in Denmark (GLA:D) registry. The registry is associated with a nationwide treatment program consisting of two to three sessions of patient education and a dozen 60-minute sessions of group-based neuromuscular exercise.
The study included 30,545 patients (mean age, 65 years; mean BMI, 29 kg/m2), 27% of whom had prior surgery in their most affected knee. For up to 3 months of follow-up, the researchers used linear regression to assess between-group differences in knee pain intensity, via 0-to-100 mm visual analog scale; joint-related quality of life, via the Knee Injury and Osteoarthritis Outcome Score quality of life (KOOS QOL) subscale; and walking speed, via 40 meter fast-paced walk test.
Overall, 27% of study participants had had surgery in their most affected knee. On average, there were improvements across all clinical outcomes in both the prior surgery and non-surgery groups.
According to the researchers, no clinically relevant between-group differences emerged in the achievement of “minimal important change” for any outcome, defined as a minimum 15 mm change in pain intensity, 10 point improvement in KOOS QOL and 0.095 m/s walking speed.
“The results from our study are valuable for future health care planning, as it suggests that the change in knee pain, joint-related quality of life and walking speed in patients with knee OA after guideline-recommended treatments is not moderated by previous surgery status,” Grønne and colleagues wrote. “This knowledge can be valuable for both patients and clinicians when discussing and managing treatment expectations, as people with knee osteoarthritis and prior knee surgery can be informed to expect an average outcome from a supervised patient education and exercise therapy program.”
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