Value of Common Knee Surgery Challenged

A study has shown that osteoarthritis patients who underwent a mock surgery, or placebo, were as likely to report pain relief as patients who had arthroscopic knee surgery. The study appeared in the July 11, 2002, issue of The New England Journal of Medicine.

Investigators randomized 180 patients with knee pain into three groups. One group received debridement, in which worn, torn, or loose cartilage was cut way and removed. The second group underwent arthroscopic lavage, in which the bad cartilage was flushed out. The third group underwent simulated arthroscopic surgery, in which small incisions were made but no instruments were inserted and no cartilage removed.

During three years of follow-up, patients in all three groups reported improvements in pain and ability to function. Neither of the intervention groups reported less pain or better function than the placebo group. In fact, placebo patients reported better outcomes than the debridement patients at certain times. Throughout the two years, the patients were unaware of which treatment they received. These results, say the investigators, raise questions about what really causes the improvements seen with lavage or debridement and suggest the same benefits may be achieved through placebo surgery.

The study was conducted by researchers at the Houston Veterans Affairs Medical Center and Baylor College of Medicine (Houston, USA). "The fact that the effectiveness of arthroscopic lavage or debridement in patients with osteoarthritis of the knee is not greater than that of placebo surgery makes us question whether the one billion plus dollars spent on these procedures might not be put to better use,” said Dr. Nelda P. Wray, lead investigator and a health services researcher.




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