By all accounts, total knee replacement is a game changer. So why subject it to a randomised, controlled trial? First, total knee replacement poses risks. About 0.5 to 1% of patients die during the 90-day postoperative period. The risks of deep venous thrombosis, pulmonary embolus, deep prosthetic infection, and periprosthetic fracture range from 0.1 to 1.0%, with higher risks among older persons and those with a higher number of coexisting conditions.

For most patients, the dramatic pain relief associated with total knee replacement provides a compelling rationale to choose surgery. Other patients, particularly those who are more risk-averse, may prefer nonsurgical care.

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