Is it difficult to decide on the total knee replacement? Totally!

It is a very important decision: If knee surgery painful?

Many people say yes. In fact, each year about 700,000 people in the United States that the most common form of arthritis of the knee undergo knee replacement surgery.

But how does it work? This is a question which has been largely answered by asking people who have had the surgery if you are happy they did. Most say yes. But the search for high-quality surgical versus non-surgical has not been done so far ... treatments.

In the last New England Journal of Medicine issue, researchers in Denmark report the results of a study that randomly assigned 95 people considered eligible for surgery knee replacement surgery or continue with more conservative treatments such as Exercise and a diet to lose excess weight. Here's what they found:

* Those who have had the surgery had more pain relief and improved function one year later than those assigned to nonsurgical treatment.

* The function and quality of life were better in those who have undergone surgery.

Does this mean that surgery is good for most people with knee arthritis? Not necessarily. Here's why:

  * Those enrolled in this study were carefully selected - which included only 95 people of nearly 1,500 that were originally selected.

  * This study excluded those who had a sharp pain in the week prior to inclusion in the study.

  * Only people with osteoarthritis - the with age-related "wear and tear" arthritis - were included. People with other types, such as rheumatoid arthritis, are not eligible.

  * Although the improvement of those receiving surgery was greater than in the non-surgical group, both groups improved. And the difference between them was not great.

  * Severe side effects or complications were more frequent in the surgery group. For example, three of the 50 people who have had surgery (against none in the non-surgical group) developed blood clots that require treatment with anticoagulants. These clots can cause dangerous complications, potentially fatal.

  * This study only lasted a year, so he can not tell us what kind of treatment is best in the long run. This is important because osteoarthritis, and the impact of major surgery, can affect the pain and function for decades.

If you have osteoarthritis of the knee, talk to your doctor about your treatment options. Surgery may be a good choice if your symptoms are bothersome, other treatments have failed, and your overall health is good enough to support the operation. However, personal preferences are very important. For example:

 * How your arthritis affects you? An avid walker can take a different decision to undergo knee surgery that a person who is less active.

 * How do you feel about the risks? All surgery comes with a high potential for complications, such as infection or bleeding. Some people are more focused on the potential improvement provided by the operation, while others are more concerned about the risks.

 * Do you have other conditions or on medications that may make riskier than average surgery?

 * How do you feel about the necessary weeks of rehabilitation after surgery?

We still easy if the knee replacement surgery is best for people with osteoarthritis answer. This study helps. But preferences objectives, personal health and lifestyle are more important.
By: Robert Shmerling, MD