Innovative Preoperative Care Approach Promising in Easing Knee Osteoarthritis Discomfort

In a groundbreaking study conducted in two UK secondary care centers, researchers explored the feasibility and efficacy of a preoperative package of non-operative care for individuals awaiting knee replacement surgery due to osteoarthritis. Osteoarthritis of the knee stands as a significant global cause of disability, prompting a search for effective interventions to enhance patient outcomes. The trial results were published in the journal The Lancet Rheumatology.

The study, an open label, randomized controlled feasibility trial, spanned from September 3, 2018, to August 30, 2019. Participants aged 15–85 years on the waiting list for knee arthroplasty for osteoarthritis were eligible. Participants were randomly assigned to the intervention group (receiving the preoperative package) or the control group (standard care). The intervention group received all four components weekly over 12 weeks and was regularly reviewed for adherence.

The primary focus was to assess the acceptability and feasibility of delivering a comprehensive preoperative intervention, consisting of weight loss, exercise therapy, insole use, and analgesia adjustment. Out of 233 initially screened patients, 60 participants met the criteria and were randomly assigned to either the intervention group (receiving the preoperative care package) or the control group (receiving standard care). Notably, 78% of the intervention group engaged in exercise therapy, showcasing varied uptake across the specified intervention components.

Results:

• The results revealed an encouraging median adherence rate of 94% among participants in the intervention group.
• Regular reviews and assessments of adherence were conducted throughout the 12-week intervention period.
• Notably, the intervention group demonstrated significant weight loss, with a mean reduction of 11.2 kg compared to a modest 1.3 kg in the control group.
• One of the most promising aspects of the study was the reported improvement in health-related quality of life in the intervention group.
• Participants in this group experienced a clinically significant enhancement in their overall well-being, as reflected in joint-specific scores.
• Importantly, no adverse events attributable to the intervention were reported, underscoring the safety of the preoperative care package.
• Participant feedback, as well as that from health professionals, was overwhelmingly positive, highlighting the acceptability of the intervention approach.

The study signifies a crucial step forward in the quest for effective preoperative interventions for knee osteoarthritis. The high adherence rates, coupled with improvements in weight management and quality of life, provide a strong foundation for advancing to a full-scale effectiveness trial.

The positive outcomes of this innovative preoperative care approach could potentially transform the landscape for individuals awaiting knee replacement surgery. As researchers and healthcare professionals continue to explore avenues for improving patient outcomes, this study opens new possibilities for optimizing non-operative treatments and enhancing the overall well-being of those grappling with knee osteoarthritis.

Further reading: A preoperative package of care for osteoarthritis, consisting of weight loss, orthotics, rehabilitation, and topical and oral analgesia (OPPORTUNITY): a two-centre, open-label, randomised controlled feasibility trial. DOI:  https://doi.org/10.1016/S2665-9913(23)00337-5