From Our 2008 Archives
Arthroscopy May Not Help Knee Arthritis
Study Shows Popular Knee Surgery May Not Reduce Symptoms of Osteoarthritis
By Robynne Boyd
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, flexiblefiber-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'sSchulich 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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