100 patients with radiographically confirmed moderate to severe knee osteoarthritis were randomized to receive either total knee replacement (TKR) followed by nonsurgical treatment or the same nonsurgical treatment alone. The purpose of the study was to compare pain, function and quality of life between the two groups to determine if greater results can be achieved when surgery is combined with nonsurgical treatment. The results demonstrated that the combination of TKR and nonsurgical interventions yielded greater improvements in pain, function and quality of life scores in 12 months. However, an increased rate of adverse events was observed in the TKR patients.