Study disputes effectiveness of arthroscopic surgery for knee osteoarthritis

Researchers reported that arthroscopic surgery provides no additional benefit to physical therapy and medication for the treatment of knee osteoarthritis, based on a new study published today in the New England Journal of Medicine.

Investigators from London, Ontario, studied 178 community-based patients who received physical therapy and medications such as ibuprofen or acetaminophen for knee OA. Eighty-six patients also underwent lavage and arthroscopic debridement.

Patients in the study group had an average age of 60 years and included those with Grade II to IV OA but did not have Grade IV OA in multiple compartments, according to a University of Western Ontario press release.

During the 2-year follow-up, the investigators found that both groups showed improvements in joint pain relief, function and stiffness at several time intervals. However, the study revealed no additional benefit in the group treated with surgery.

“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,” Brian Feagan, MD, study co-author and clinical trials director at the Robarts Research Institute at The University of Western Ontario, said in the press release.

Orthopedic surgeons at the Fowler Kennedy Sport Medicine Clinic at London Health Sciences Centre conducted the study from 1999 to 2007. The Clinical Trials Group at Robarts Research Institute coordinated the investigation, and the Canadian Institutes of Health Research provided study funding.

Study co-author Robert B. Litchfield, MD, FRCSC, acknowledged that knee arthroscopy still plays an important role in the treatment of other knee injuries and said the current research only focused on OA-related knee problems.

“Although this study did not show a significant therapeutic benefit of arthroscopic debridement in this patient population, knee arthroscopy is still beneficial in many other conditions affecting the knee such as meniscal repair and resection, and ligament reconstruction,” he said in the release.

However, “As surgeons, we need to know when things are working and when they are not. If this particular technique is not working for this subgroup of patients, we better come up with something else that does.”

For more information:
Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Eng J Med. 359:1097-1107.
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