Arthroscopy May Not Help Knee Arthritis
Study Shows Popular Knee Surgery May Not Reduce Symptoms of Osteoarthritis
By Robynne Boyd
WebMD Health News
Reviewed By
Louise Chang, MD
Sept. 10, 2008 — Arthroscopic knee surgery for people suffering from
osteoarthritis doesn't reduce joint symptoms or improve its function compared
with optimal nonsurgical treatment.
That's according to a new study published in The New England Journal of
Medicine.
Researchers at the University of Western Ontario and the Lawson Health
Research Institute in Canada examined the effectiveness of arthroscopic
surgery, a widely accepted method for treating osteoarthritis of the knee. It
involves small incisions to insert a thin, flexible fiber-optic scope and
other small instruments into the knee joint to remove pieces of cartilage and
smooth the joint surfaces. Arthroscopy is also used to repair other knee
problems.
The research team was composed of orthopaedic surgeons, rheumatologists, and
physiotherapists. They treated 178 London-area patients with moderate to severe
osteoarthritis of the knee from 1999 to 2007. The participants were on average
60 years old.
All of the patients were provided with physical therapy as well as
medications such as ibuprofen or acetaminophen; 86 of the patients also
received arthroscopic surgery. They were then tracked for two years to assess
the severity of their osteoarthritis.
Arthroscopy vs. Nonsurgical Treatment
The researchers found that both groups of patients experienced similar
improvements in joint pain, stiffness, and function.
At the end of two years, the researchers concluded that compared with
nonsurgical treatment, arthroscopic surgery of the knee did not improve joint
symptoms or function for people suffering from osteoarthritis of the knee.
"This study provides definitive evidence that arthroscopic surgery
provides no additional therapeutic value when added to physical therapy and
medication for patients with moderate osteoarthritis of the knee," says
study researcher Brian Feagan, MD, clinical trials director at the Robarts
Research Institute at the University of Western Ontario and a professor of
medicine, and epidemiology and biostatistics at the university's Schulich
School of Medicine & Dentistry.
However, Bob Litchfield, MD, an orthopaedic surgeon and one of the study's
researchers, explained that the study focused on arthritis-related knee
problems, emphasizing that arthroscopic knee surgery is still beneficial in
many other conditions that affect the knee, such as meniscal and ligament
problems.
"As surgeons, we need to know when things are working and when they're
not," says Litchfield of the Fowler Kennedy Sport Medicine Clinic and the
University of Western Ontario.
An editorial published in the same issue of The New England Journal of
Medicine supported this idea. The editorial was written by Robert Marx, MD,
an orthopaedic surgeon from the Hospital for Special Surgery and Weill Medical
College of Cornell University; it reiterated that this study did not attempt to
treat patients who have a combination of knee ailments, such as osteoarthritis
and a meniscal tear. Marx stresses that in the presence of both problems and
knee pain, "it can be difficult to determine which of the two is the major
cause."
Marx says that while the study's results demonstrate that arthroscopic
surgery is not indicated in treating patients who only have osteoarthritis of
the knee, it can still be appropriate for patients with a combination of knee
problems. It is important to "to individualize decision-making with respect
to arthroscopic surgery for patients with osteoarthritis of the knee."
SOURCES: Kirkley, A. The New England Journal of Medicine, Sept. 11, 2008; vol
359: pp 1097-1107. Marx, R. The New England Journal of Medicine, Sept. 11, 2008; vol
359: pp 1169-1170. News release, University of Western Ontario. Brian Feagan, MD, clinical trials director, Robarts Research Institute,
University of Western Ontario; professor of medicine, epidemiology and
biostatistics, University of Western Ontario Schulich School of Medicine &
Dentistry. Bob Litchfield, MD, orthopaedic surgeon, Fowler Kennedy Sport Medicine
Clinic and the University of Western Ontario.
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