The first randomized trial of total knee replacement (TKR) enrolled 100 patients with osteoarthritis who were considered eligible for this procedure. TKR followed by 12 weeks of nonsurgical treatment was more effective than nonsurgical treatment alone (exercise, education, dietary advice, use of insoles, and pain medication) in reducing pain and improving function and quality of life after 12 months. However, both groups experienced clinically relevant improvements, and more serious adverse events occurred in the TKR group.