Does arthroscopic lavage and debridement surgery for osteoarthritis of the knee actually work??

I recently saw a man who was known to have long-standing knee osteoarthritis. He was having persistent pain and wanted to know if arthroscopy and a “flush-out” and cutting away diseased areas would help him. This is a common question posed to us, as knee arthritis is becoming more prevalent. Many patients report relief following arthroscopic surgery for arthritis so often there is an expectation that the surgery actually does something beneficial. Uncontrolled studies showed that half the patients got relief.

Some researchers in the U.S. [1] studied this with a rather interesting technique. They conducted a randomised double-blinded study where patients who had this problem had sham/placebo arthroscopic surgery or real arthroscopic surgery. The sham surgery patients had an anaesthetic and the usual incisions but no actual arthroscopy done. The others had the usual procedures. They all had the same pre-op and post-op protocols so that the patients would not be able to tell which group they were in.

Interestingly, 87% of both groups thought they had had the real surgery. On measures of pain and function, the sham surgery patients were at least as good or better than the patients who had had real surgery. So this type of surgery doesn’t seem to do anything, but if patients think they have had surgery there is a marked placebo effect. This sort of evidence should be kept in mind for patients having this type of surgery recommended.

I will be writing more on this type of research in the next update. Please contact me for more information 98977699 or david allen@qoh.com.au.

Reference:

1. Moseley, J.B., et al., A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med, 2002. 347(2): p. 81-8.