Significant quality of life improvement following total knee replacement for end-stage osteoarthritis: Retrospective cohort study

BACKGROUND 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 standardized patient-reported outcome measures remains limited, particularly from the Middle East. This study addresses this gap by evaluating HRQoL changes in a Saudi Arabian cohort. AIM 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. METHODS 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. RESULTS 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). CONCLUSION 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.