I completely agree. We need a lot more longitudinal data. We know arthritis is a normal part of aging and many older adults live with little or no pain and elect to forgo TKRs. A challenge with longitudinal data is more variables enter the fold as time passes. There isn’t a universal answer to this question. I’ve treated many patients that thrives after a TKR and failed conservative care. Perhaps the rehab could have been better. Perhaps a TKR was inevitable. Some people could do either but for a multitude of reasons chose one over the other. I want people to know there are options and surgery should be used as a last resort.