Published online Mar 18, 2026. doi: 10.5312/wjo.v17.i3.115537
Revised: November 4, 2025
Accepted: December 17, 2025
Published online: March 18, 2026
Processing time: 148 Days and 10 Hours
Total knee replacement (TKR) is a cornerstone intervention for advanced knee osteoarthritis (OA), yet real-world data directly comparing its impact on health-related quality of life (HRQoL) against non-surgical management using standar
To compare the change in HRQoL, measured by the EuroQol five-dimension, five-level questionnaire (EQ-5D-5 L) instrument, between patients undergoing TKR and those receiving conservative treatment for severe knee OA.
This retrospective cohort study was conducted at a tertiary orthopedic center in Saudi Arabia, analyzing data from patients with Kellgren-Lawrence grade III-IV knee OA between January 2018 and December 2022. This study is reported following the STROBE guidelines. Patients were allocated into two groups: The TKR group (n = 480) and the conservative management group (n = 400). The primary outcome was the change in the EQ-5D-5 L index score from baseline to one-year post-intervention. Statistical analyses included paired and independent t-tests, with a P value < 0.05 considered significant.
A total of 880 patients were included in the final analysis. The TKR group demonstrated a substantial and clinically significant improvement in mean EQ-5D-5 L scores, from 0.35 ± 0.08 at baseline to 0.76 ± 0.09 at one year (mean change: +0.41; 95% confidence interval: 0.39-0.43; P < 0.001). This improvement far exceeded the minimal clinically important difference of 0.07-0.12. In contrast, the conservative management group showed a minimal, non-significant improvement from 0.36 ± 0.07 to 0.42 ± 0.08 (mean change: +0.06; 95% confidence interval: 0.04-0.08; P = 0.07), which did not meet the minimal clinically important difference. The between-group difference in HRQoL improvement was statistically significant (P < 0.001).
This study provides strong evidence that TKR leads to substantial and clinically meaningful improvements in HRQoL for patients with severe knee OA, whereas conservative management offers limited benefits. These findings reinforce the effectiveness of TKR in the management of advanced OA, support timely surgical referral, and validate the use of the EQ-5D-5 L as a robust patient-reported outcome measure in this patient population.
Core Tip: Total knee replacement is a highly effective procedure for improving the quality of life in patients with severe knee osteoarthritis. This retrospective cohort study from a major Saudi Arabian orthopedic center provides strong evidence that surgical intervention offers substantial and clinically meaningful benefits over conservative management, as measured by the EuroQol five-dimension, five-level questionnaire patient-reported outcome measure. These findings support prioritizing timely surgical referrals for eligible candidates to maximize improvements in health-related quality of life.