Background More than 670,000 total knee replacements are performed annually in the
United States; however, high-quality evidence to support the effectiveness of the procedure,
as compared with nonsurgical interventions, is lacking. Methods In this randomized,
controlled trial, we enrolled 100 patients with moderate-to-severe knee osteoarthritis who
were eligible for unilateral total knee replacement. Patients were randomly assigned to
undergo total knee replacement followed by 12 weeks of nonsurgical treatment (total-knee …

To the Editor: In the study reported by Skou and colleagues (Oct. 22 issue), 1 patients were
excluded if they had symptomatic knee osteoarthritis with pain scores higher than 60 mm on
a visual-analogue scale (on which scores range from 0 to 100, with higher scores indicating
worse pain). We are unclear as to the rationale for excluding patients with this level of pain,
who are commonly seen in orthopedic practice. We agree with the conclusion that total knee
replacement is superior to the nonsurgical regimen investigated. However, we are …