Arthroscopic Knee Surgery for OA... Is It Worth It?
BY JOHN MCCORMICK, SEPTEMBER 16, 2008
Last week, the New England Journal of Medicine published a study that more or less said "no". In cautionary scientific parlance, the study concluded that "arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy". The article has been making news outside of the clinical community even to the point of being discussed in New York taxicab video feeds.
This single center trial randomized 188 patients and 163 ultimately completed two year follow up. Importantly, the study did not include abrasion or microfracture of chondral defects as a treatment. Therefore, we don't consider it conclusive concerning those specific arthroscopic surgical procedures.
Since osteoarthritis ("OA") is degenerative, different treatments apply at different times and the continuum of care is effectively multidisciplinary. The range of treatments includes OA bracing, physical therapy, synolvial fluid injections, medication and intermediate surgery. The end of the line is full knee replacement.
The study addresses moderate-to-severe OA where intermediate surgery is typically considered. Patients who were randomly assigned sugery in the study were treated with the insertion of an arthroscope and subjected to appropriate synovectomy and/or debridement such that degenerative tears of the menisci, fragments of articular cartilage, or chondral flaps and/or osteophytes are sugically removed. Patients assigned to surgery also underwent standard post-op physical therapy. 83 of the 94 patients assigned to surgery completed the study. The non-surgery physical therapy control was kept to an impressively defined regimen and 80 of the 94 patients assigned to this program completed the study.
The conclusion, in a nutshell, was that patients undergoing arthroscopic surgery were no more likely to experience improvements in physical function, pain or health-related quality of life than rigorous physical therapy. The good news is that both patient groups fared better after undergoing treatment. The problem is that they fared the same.
