Arthroscopic Knee Surgery Called Unnecessary

A new study claims that one of the most common orthopedic surgical procedures performed, arthroscopy to treat arthritis in the knee, is useless, conferring no added benefits when compared to drugs or physical therapy.

Researchers at of the University of Western Ontario (London, Canada) conducted a single-center, randomized controlled trial of arthroscopic surgery in 178 patients with moderate-to-severe osteoarthritis (OA) of the knee. All patients received standard nonsurgical treatment, including physical therapy, painkillers such as acetaminophen and ibuprofen, glucosamine supplements, and injections to lubricate the joint. Patients were then randomly assigned to additional surgical lavage and arthroscopic debridement, or to continued treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) physical component summary score.

The study results showed that of the 92 patients assigned to surgery, six did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean WOMAC score for the surgery group was 874(+/- 624), as compared with 897 (+/- 583) for the control group. The SF-36 physical component summary scores were an average 37 and 37.2 respectively. Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show any superiority of surgery. The study was published in the September 11, 2008, issue of the New England Journal of Medicine (NEJM).

"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,” said lead author Brian Feagan, M.D., a professor in the departments of medicine and epidemiology and biostatistics. "If it isn't effective, patients should not be undergoing it.”

The researchers stressed that surgery could help people who have problems other than arthritis, such as a badly torn ligament or cartilage. They added that they hope the new research will encourage surgeons to be much more selective in offering the operations, and that patients will be less aggressive about demanding it.

Related Links:
University of Western Ontario