Impact of prior knee surgery on change in knee pain, quality of life, and walking speed following supervised education and exercise therapy: an analysis of 30,545 people with knee osteoarthritis

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To investigate the impact of prior knee surgery on changes in outcomes following an 8-week supervised patient education and exercise therapy program in patients with knee osteoarthritis. Patients were classified according to knee surgery in the most affected knee joint (yes/no) prior to enrolment in the Good Life with osteoArthritis in Denmark (GLA:D®) program. Between-group differences in outcome changes from baseline to 3 months follow-up were evaluated using linear regression stratified by sex. Outcomes were knee pain intensity (VAS, 0–100 mm), joint related quality of life (Knee Injury and Osteoarthritis Outcome Score Quality of Life subscale score (KOOS QOL, 0–100)) and walking speed (40-m fast-paced walk test). To evaluate clinically relevant between-group differences, proportions of patients reaching a threshold of minimal important change in the surgery and non-surgery groups were compared. Among 30,545 patients, 27% (n, 8254) had prior surgery in the most affected knee. The prior surgery and the non-surgery group experienced improvements in all outcomes with minor between-group differences in change in pain intensity (males, 0.03 95% CI − 0.9 to 1.0; females, 1.3 95% CI 0.6 to 2.1); KOOS QOL (males, 0.3 95% CI − 0.4 to 0.9; females 0.02 95% CI − 0.5 to 0.5); and walking speed (males, 0.01 95% CI − 0.01 to 0.02; females 0.01 95% CI 0.003 to 0.02). The responder analysis showed no clinically relevant between-group differences in improvements. Previous knee surgery does not seem to modify the clinical outcome following exercise therapy and patient education in patients with knee osteoarthritis.Key Points• About one in four patients with knee osteoarthritis participating in an 8-week supervised patient education and exercise therapy program had previous knee joint surgery in the most affected knee.• Those with prior knee surgery were more likely to be males, to have prior knee injury, to have a longer symptom duration, and to have a high physical activity level compared to those without previous knee surgery.• Patients with prior knee surgery did not experience clinically relevant less change in knee pain, joint related quality of life, and walking speed after participation in the intervention, compared to those without previous knee surgery.• Patients with previous knee surgery can expect clinical outcomes following exercise therapy and patient education similar to patients without prior knee joint surgery.