title: Nonoperative treatment improves pain irrespective of radiographic severity. A cohort study of 1,414 patients with knee osteoarthritis.
abstract: OBJECTIVE
  The discrepancy between symptoms and radiographic severity of knee osteoarthritis (OA) is well described. However, little is known about whether radiographic severity is predictive of the clinical result of nonoperative treatment. We investigated whether radiographic severity and treatment type were associated with improvements in pain after nonoperative treatment of patients with knee OA.
  
  
  METHODS
  A 5-year consecutive series of patients deemed not eligible for total knee arthroplasty (TKA) by an experienced orthopedic surgeon was contacted 1-5 years later. Radiographic severity, age, sex, and BMI were registered at the consultation. At follow-up, patients were asked to answer a questionnaire on type of treatment and improvements in pain after treatment.
  
  
  RESULTS
  Of 1,848 patients who were not eligible for TKA, 1,414 (77%) completed the follow-up questionnaire (mean age 66 (24-96) years; 55% women). Radiographic severity was not associated with improvements in pain even after adjusting for treatment type, age, sex, and BMI (p > 0.1). The odds ratio of improvement was higher by a factor of 2 in patients who received physiotherapy or multimodal treatment than in patients who did not.
  
  
  CONCLUSIONS
  Radiographic severity was not associated with improvements in pain after nonoperative treatment. Patients who are not eligible for TKA can confidently be referred to nonoperative treatment even if they have severe radiographic OA. The treatment should preferably be multimodal, including physiotherapy, as recommended in Danish and international clinical guidelines.
authors.affiliation: a 1 Orthopaedic Surgery Research Unit, Aalborg University Hospital.|b 2 Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University.
authors.forename: Søren T
authors.initials: ST
authors.lastname: Skou
authors.affiliation: a 1 Orthopaedic Surgery Research Unit, Aalborg University Hospital.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Derosche
authors.affiliation: c 3 Department of Mathematical Sciences, Aalborg University , Aalborg, Denmark.
authors.forename: Mikkel M
authors.initials: MM
authors.lastname: Andersen
authors.affiliation: b 2 Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rathleff
authors.affiliation: a 1 Orthopaedic Surgery Research Unit, Aalborg University Hospital.
authors.forename: Ole
authors.initials: O
authors.lastname: Simonsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000628:therapy*; D010146:Pain / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult