Arthroscopy for degenerative knee arthritis relieves symptoms and defers TKR

Over half of the patients reported symptom improvement from OA and many other problems.

HOLLYWOOD, Fla. — Arthroscopy for degenerative knee arthritis, a controversial topic in orthopedic circles, meets the patient objective to avoid total knee arthroplasty while improving symptoms, a recent study shows.

In that study, 593 patients at a private practice opted for arthroscopic debridement over total knee arthroplasty to relieve degenerative arthritis symptoms, according to Lanny L. Johnson, MD, of Okemos, Mich.

They found that just over half of the patients improved at an average of five years postop.

“The surgical procedure debrided [the patients’] pathological lesions, mechanical problems, inflammation, loose bodies and osteoarthritis,” Johnson said at the Arthroscopy Association of North America 25th Annual Meeting. “The patient objective was achieved. These folks didn’t want a total knee and they never got one. They were ‘copers,’ meaning they had the personality and persuasion to cope with their condition. They had symptomatic improvement.”

Researchers reviewed patient data collected during the point of service from 1984 to 1994. Follow-up was opportunistic, Johnson said.

“There was no single complaint that these people had,” he said. “Pain was the most common and they had multiple other complaints, which you might guess happens with degenerative arthritis.”

Patients listed the following chief complaints: 66% pain, 27% swelling, 32% aching/sore, 20% loss of activities, 14% limping, 20% grinding, 14% loss of motion, 20% going out, 4% buckling, 3% stiffness and 4% loss of work.

Secondary complaints included problems ambulating, activity limitations, limited walking, locking and using walking aids, Johnson said.

Researchers found physical exam results for 373 patients, showing that most experienced crepitus (37%). Also, 29% tested positive for effusion, 27% had range of motion loss, and 17% had positive McMurray tests — among other symptoms.

“The surgical indications clearly [showed] there were mechanical problems and synovitis by the history and physical examination and [patients] were otherwise candidates for total knee,” Johnson said.

All patients demonstrated severe degenerative arthritis on X-ray. The intraoperative lesions were complex and multiple. All patients had Grade IV Outerbridge lesions or exposed bone. Further, 95% had a torn meniscus, 61% had significant synovitis, 45% had excessive joint fluid and 36% had loose bodies.

“They all had an abrasion, but they had a high incidence of synovectomy, chondroplasty, meniscectomy, loose body removal and resection of osteophytes,” Johnson said.

Long-term follow-up results up to 10 years (average, five years) were available for 192 patients (32%). “Twenty-six percent said they had no problem to an initial question, but it wasn't really true because they all had some kind of complaint listed later in the questionnaire,” Johnson said.

At follow-up, 56% of patients reported improvement, 7% said they remained the same and 7% claimed their symptoms worsened. Eight percent had a reoperation, including 12 with arthroscopy and three with open surgery.

Patients had improvement in swelling, loss of motion, grating/grinding, locking, buckling and aids for walking. “Twenty-two percent at the average five years said they had no pain, but what you should know is that pain increased over time so that by 10 years everybody had pain reported in the follow-up,” Johnson said.

Researchers also saw physical exam improvement for: effusion, catching, popping, McMurray test and gait.

For more information:
Johnson L, Pittsley A. Arthroscopy for degenerative arthritis of the knee. #SS-23. Presented at the Arthroscopy Association of North America 25th Annual Meeting. May 18-21, 2006. Hollywood, Fla.