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Limit use of knee arthroscopy to younger patients with OA and normal joint space

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ORLANDO, Fla. — Arthroscopy has limited use as a diagnostic or treatment tool in most patients with knee osteoarthritis who are likely to be indicated for arthroplasty in the near future, according to an orthopedic surgeon at the University of California at Davis.

“[However,] arthroscopy can be beneficial in carefully selected patients,” Stephen M. Howell, MD, said at during his presentation at the 26th Annual Current Concepts in Joint Replacement Winter Meeting, here.

He recommended checking the MRI in patients older than 45 years without joint space narrowing before performing or ordering the arthroscopy because it can be helpful in identifying sites of cartilage wear.

“Limit the arthroscopy to those patients who truly are symptomatic from loose bodies or meniscal tears,” Howell noted.

Placebo effect

The guidelines on treating knee osteoarthritis (OA) issued by the American Academy of Orthopaedic Surgeons in 2008 and some widely cited studies recommend against arthroscopic lavage, debridement and removal of loose bodies in patients with arthritis.

In addition, Howell could not support the wide-scale use of arthroscopy.

“Arthroscopy has a placebo effect,” he said “That means it works. It does not mean you will have better results with it as a possible medical therapy.”

In fact, the procedure could have complications associated with it in certain groups.

Howell said that surgeons can learn a lot from looking at a knee MRI because it can show fluid on cortical bone, indicating that the cartilage is worn away, or reveal a subchondral fracture typical of avascular necrosis. Both of these MRI findings would negate the need to do an invasive arthroscopy examination.

• Reference:

Howell SM. The role of arthroscopy: Beneficial, placebo or worse? Paper #67. Presented at the 26th Annual Current Concepts in Joint Replacement Winter Meeting. Dec. 9-12, 2009. Orlando, Fla.

Howell is a consultant to Biomet Sports Medicine and OtisMed Inc., and is a major stockholder with OtisMed Inc.