"I Was Told I Needed Both Knees Surgically Replaced, but I Walked the Camino Trail Instead." A Case Report of A 66-year-old Male with Knee Osteoarthritis.

BACKGROUND

This case report describes the lived experience of a 66-year-old male (PN) with bilateral knee osteoarthritis whose engagement with best practice conservative management resulted in a positive outcome of unanticipated scope/magnitude. PN had long-term symptomatic knee osteoarthritis and was advised that bilateral arthroplasty was required. He chose to avoid surgery, instead participating in a clinical trial evaluating the effect of embedding pain science education (PSE) into an individualized, graded exercise program (EPIPHA-KNEE trial).

METHODS

The intervention involved four weekly in-person sessions, five telehealth sessions (weeks 5-8, 12), and two top-up in-person sessions (weeks 21, 39). A key intervention component was activity-related goal setting, with cognitive reconceptualization and activity progression underpinned by PSE. PN set an "aspirational goal" - to walk the Camino de Santiago Trail. Clinical outcomes and device-measured activity levels were assessed at baseline, 8, 26 and 52 weeks.

RESULTS

Relative to baseline, PN experienced improvements in knee pain (83% reduction), function (71% improvement), and activity levels (50% increase) at 52 weeks with cessation of pain medication use and resolution of knee swelling and night pain. PN experienced continuing benefit, walking 320 km of the Camino Trial in 14 days one year after trial completion.

CONCLUSION

PN's achievement of his aspirational goal is an exemplar of the unanticipated scope of osteoarthritis improvement with best-practice non-surgical management and is shared via a video interview. Documenting and sharing such inspirational stories with people living with knee osteoarthritis may prove an important source of hope and highlight the change potential for non-surgical treatment.