American Board of Internal Medicine (ABIM) Certification Practice Exam

What is considered the most efficacious treatment for severe osteoarthritis of the knee that hasn't responded to other treatments?

1. Physical therapy

2. Injections of hyaluronic acid

3. Total knee replacement (TKR)

4. Oral analgesics

The correct answer is: Total knee replacement (TKR)

Total knee replacement (TKR) is considered the most efficacious treatment for severe osteoarthritis of the knee when other treatments, such as physical therapy, injections, and oral analgesics, have not provided adequate relief. This surgical procedure involves replacing damaged or diseased knee joint surfaces with artificial components, significantly alleviating pain and improving function in patients who experience debilitating symptoms from osteoarthritis. Severe osteoarthritis may lead to considerable joint degeneration, and in cases where conservative management has failed, TKR offers the potential for substantial pain relief and a return to normal activities that were previously limited by joint issues. Clinical studies have shown that TKR can provide significant improvements in both pain levels and physical function, making it a reliable option for those who have not responded to less invasive treatments. In contrast, while physical therapy can improve strength and range of motion, it may not resolve severe pain or functional limitations in advanced cases. Injections of hyaluronic acid, though used for symptom relief, have a variable success rate, particularly in cases of severe osteoarthritis. Oral analgesics, like NSAIDs, can help manage pain but may not be sufficient for those with significant joint damage or debilitating symptoms. Therefore, TKR stands out as the most effective intervention for patients whose quality