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The Pain & Therapy Bibliography, Record ID 3705 {show all records}

A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee


added Sep 11, 08, updated Jan 14, 10
most detailed summaries by Paul Ingraham

summary

In 2002, Moseley published the results of a fascinating experiment that showed that people who received a fake arthroscopic knee surgery had results just as good as people who received the real surgery for osteoarthritis. Six years later, these findings were fully supported by a Cochrane Collaboration review (Laupattarakasem) early in 2008, which concluded that “there is ‘gold’ level evidence that arthoscopic debridement has no benefit.” As if that wasn’t enough, this study “piled on” and reported that surgery provides “no additional benefit” compared surgery to “optimized physical and medical therapy.”

item type
article in a journal
authors
Alexandra Kirkley, Trevor B. Birmingham, Robert B. Litchfield, J. Robert Giffin, Kevin R. Willits, Cindy J. Wong, Brian G. Feagan, Allan Donner, Sharon H. Griffin, Linda M. D'Ascanio, Janet E. Pope, and Peter J. Fowler
link
http://content.nejm.org/cgi/content/abstract/359/11/1097
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journal
New England Journal of Medicine
year
2008
volume
359
number
11
pages
1097-1107

abstract

Background The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown. Methods We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic debridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life). Results Of the 92 patients assigned to surgery, 6 did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean ([+/-]SD) WOMAC score for the surgery group was 874[+/-]624, as compared with 897[+/-]583 for the control group (absolute difference [surgery-group score minus control-group score], -23[+/-]605; 95% confidence interval [CI], -208 to 161; P=0.22 after adjustment for baseline score and grade of severity). The SF-36 Physical Component Summary scores were 37.0[+/-]11.4 and 37.2[+/-]10.6, respectively (absolute difference, -0.2[+/-]11.1; 95% CI, -3.6 to 3.2; P=0.93). Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery. Conclusions Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy. (ClinicalTrials.gov number, NCT00158431 .)

related content

  1. “A controlled trial of arthroscopic surgery for osteoarthritis of the knee,” an article in New England Journal of Medicine, 2002.
  2. “Arthroscopic debridement for knee osteoarthritis,” an article in Cochrane Database of Systematic Reviews, 2008.

One article on SaveYourself.ca cites this paper as a source: