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Knee arthroscopy provides little benefit to those with OA in randomized trial

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LAS VEGAS — A randomized control trial that was underway in Canada at about the same time J. Bruce Moseley, MD, and others conducted their controversial, now-famous placebo-controlled knee arthroscopy trial detected no differences in knee-specific outcomes at 2 years postop for individuals with knee osteoarthritis treated arthroscopically or nonsurgically.

Investigators for this new study hypothesized that patients treated with arthroscopic debridement and lavage would improve compared to their nonoperatively treated counterparts, Peter J. Fowler, MD, said.

These results show “arthroscopy is rarely indicated for the treatment of osteoarthritis (OA) in the knee,” Fowler said when he presented the results at the American Academy of Orthopaedic Surgeons 76th Annual Meeting, here.

Patients included in the study had knee OA that was Kellgren-Lawrence grade 2 and no severe alignment problems. Anyone older than 60 years with severe or bicompartmental disease or a large meniscal tear was excluded in an attempt to limit the knee pathology as much as possible to OA alone. One-hundred eighty-eight patients were originally randomized; however, some crossover occurred between the groups during follow-up, ultimately resulting in 83 patients in the arthroscopic and 80 patients in the nonsurgical group.

Based on the primary endpoint — the WOMAC score at 2 years after randomization — investigators detected no differences between the groups’ outcomes after adjusting for initial differences in baseline WOMAC scores and Kellgren-Lawrence grades, Fowler said.

Nonsurgical care consisted of optimized medical management, physical therapy and education, some of which the surgical patients also received. Surgeons performed the arthroscopic procedures they felt the patients being needed most, ranging from lavage to osteophyte removal, the researchers wrote in their abstract.

For more information:

• Fowler PJ, Birmingham TB, Litchfield RB, et al. An RCTI comparing arthroscopic surgery to non-surgical care for knee osteoarthritis (OA). Paper #334. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.