April 2026, Volume 4, Issue 4

Author

Ravikrishna Ramesh, R. Rupesh Kanna and M. Vinoth Kumar

Abstract

Background: Optimal timing of total knee replacement (TKR) in patients with advanced knee osteoarthritis (OA) remains debated. Whether immediate TKR combined with standardized non-surgical management provides superior functional outcomes compared with continued non-surgical management alone is uncertain particularly in Indian population. Aim is to compare outcomes of immediate total knee replacement versus non-surgical management and identify predictors of recovery. Methods: This prospective, observational comparative cohort study enrolled 60 patients (50-80 years) with Kellgren-Lawrence grade III-IV knee OA who were eligible for TKR. Participants were allocated based on clinical decision and patient preference into immediate TKR plus standardized non-surgical management or standardized non-surgical management alone. The primary outcome was change in KOOS4 score from baseline to 12 months. Secondary outcomes included KOOS subscales, Timed Up and Go (TUG) test, 20-m walk test, patient satisfaction, adverse events and predictors of recovery. Analyses followed intention-to-treat principles. Results: Baseline characteristics were comparable between groups. At 12 months the immediate TKR group demonstrated significantly greater improvement in KOOS4 compared with the non-surgical group (78.6 ± 7.4 vs. 60.9 ± 10.2; between-group difference +17.7; 95% CI 12.3-23.1; p<0.001). Secondary outcomes including KOOS pain, activities of daily living, quality of life, TUG and 20-m walk test were all significantly better in the immediate TKR group (p<0.001). A higher proportion of patients undergoing immediate TKR achieved the minimal clinically important difference for KOOS4 (86.7% vs. 46.7%; p=0.003) and reported greater satisfaction and functional independence. Conclusion: Immediate TKR combined with standardized non-surgical management results in superior functional outcomes and patient-reported benefits compared with non-surgical management alone at 12 months.