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Title: Arthroscopy Does Not Benefit Patients With Osteoarthritis of the Knee, Say Investigators
URL: http://www.pslgroup.com/dg/22C13E.htm
Doctor's Guide
September 12, 2008

NEW YORK -- September 12, 2008 -- Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimised physical and medical therapy, according to a study published in the September 11 issue of the New England Journal of Medicine.

However, in an accompanying editorial, Robert G. Marx, MD, Hospital for Special Surgery, New York, New York, points out that the study has some weaknesses and argues strongly that arthroscopy does have a role in some patients with osteoarthritis.

"Arthroscopy is still valuable and you have to know when to use it," says Dr. Marx. "While I do not recommend arthroscopy as a treatment for an arthritic knee, it can be extremely helpful for people with arthritis who also have a coexisting knee problem such as a meniscal tear or a loose piece of cartilage that is causing the majority of their symptoms."

In the study, investigators randomised 92 individuals to arthroscopic surgery and 86 to nonoperative treatment for osteoarthritis of the knee.

The nonoperative treatments included 1 physical therapy session per week for 12 weeks with a home physical therapy program, patient education, and the stepwise use of acetaminophen, nonsteroidal anti-inflammatory drugs, glucosamine, and an injection of hyaluronic acid. The study did not identify any benefit in the group that received surgery.

Dr. Marx points out, however, that the study excluded patients who were believed to have a large meniscal tear based on clinical examination or, in a small number of cases, identified through magnetic resonance imaging.

Although the study showed a lack of efficacy of arthroscopy, it can be very useful in patients who may have osteoarthritis, but also another knee injury, such as a symptomatic meniscal tear.

There are subtleties involved in clinical decision making, commented Dr. Marx. Patients who are young, have mild osteoarthritis, a history of injury, and clear meniscal pathology would be a good candidate for surgery. In contrast, patients who have symptoms that are only due to osteoarthritis are unlikely to benefit from arthroscopy.

SOURCE: Hospital for Special Surgery

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