"A Randomized, Placebo-Controlled Trial of Arthroscopy for Osteoarthritis of the Knee"
Links to original sources: Wiki Journal Post Full Journal Article
Does arthroscopic surgery improve pain and function in patients with osteoarthritis of the knee more than placebo surgery?
Arthroscopic lavage and débridement did not result in improved pain or function when compared with placebo surgery for patients with osteoarthritis of the knee.
Arthroscopic surgery is a common intervention for knee osteoarthritis, yet its efficacy compared to placebo had not been rigorously evaluated. This randomized, placebo-controlled trial involving 180 patients found no difference in pain relief or improved function between those who underwent arthroscopic lavage or débridement and those who received placebo surgery over a 24-month period.
Current clinical practice guidelines have moved away from recommending arthroscopic interventions like lavage and débridement for knee osteoarthritis, focusing instead on non-surgical approaches such as physical therapy, weight loss, and pain management.
- Randomized, double-blind, placebo-controlled trial - N=180 patients with osteoarthritis of the knee - Interventions: arthroscopic débridement, arthroscopic lavage, or placebo surgery - Follow-up period: 24 months - Primary outcomes: self-reported knee pain severity and functional assessment; objective test of walking and stair climbing.
- Inclusion criteria: Patients ≤75 years with osteoarthritis of the knee, experiencing moderate to severe knee pain despite 6 months of medical treatment, and no arthroscopy in the previous 2 years. - Exclusion criteria: Severe osteoarthritis (grade ≥9), severe deformity, and serious medical problems. - 165 patients completed the trial.
- Arthroscopic débridement: involved joint lavage with 10 liters of fluid, removal of loose debris, trimming of torn meniscal fragments, and smoothing of meniscus and articular cartilage. - Arthroscopic lavage: 10 liters of fluid lavage without mechanical débridement or tissue removal, except in cases of mechanically unstable meniscal tears. - Placebo surgery: simulated arthroscopic procedure without arthroscopic insertion or tissue removal.
- Primary: Knee pain at 24 months using the Knee-Specific Pain Scale (KSPS) - Secondary: Additional assessments of pain and function including scales from the Arthritis Impact Measurement Scales (AIMS2-P and AIMS2-WB) and the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36-P and SF-36-PF), as well as an objective Physical Functioning Scale (PFS).
- Study participants were mostly men, as trials were conducted at a Veterans Affairs medical center, potentially limiting generalizability. - High refusal rate of eligible patients, possibly due to knowing the one-in-three chance of undergoing a placebo procedure, may have introduced selection bias. - All procedures performed by a single surgeon, though highly skilled, could affect the applicability of the results to other surgeons' practices.
- Department of Veterans Affairs
Original publication available in The New England Journal of Medicine (NEJM), 2002, with supplementary material regarding detailed research protocols and methods.