Is Non Surgical CaRE Using Treat to Target Multimodal meDIcal Strategies aBLE to Delay or Avoid Total Knee Replacement?

Summary

Knee is the most common site of osteoarthritis. Treatment of knee osteoarthritis starts with a full course of medical therapy, followed by surgery to replace the knee with a prosthesis if this strategy fails, or in advanced cases. However, the new recommendations of the French rheumatology society, which evaluate the various treatments and position them in the treatment plan, are not well known, and the definition of a complete treatment remains unclear. The vast majority of patients are therefore referred to a surgeon after having tried a small part of the therapeutic arsenal (generally analgesics and corticosteroid or hyaluronic acid infiltrations). The goal of this study is to to select patients most likely to gain from surgery and to develop strategies that avoid the need for major surgery.

Eligibility

Inclusion Criteria:

* Age 18-90 years old
* Femoro-tibial osteoarthritis Kellgren stage stage≥ 2 without laxity in extension;
* A proposal of total knee replacement by a surgeon;
* No corticosteroid joint injection within 3 months;
* Visual analogic score pain (VAS) \>40/100 but \<90/100 or Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index function sub scale \>40/100 at inclusion;
* Wish to discuss medical care;
* Able to consent and having signed a consent form.

Exclusion Criteria:

* Contraindication or no indication to surgery or medical care (severe infection for example)
* Inflammatory arthritis
* Lack of social insurance
* Symptomatic (VAS pain \>40) contralateral knee or hip osteoarthritis (with or without replacement)
* Pregnant or breastfeeding woman
* Patient under court protection, guardianship, curatorship
* Patient deprived of liberty

Conditions2

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