Arthroscopic knee surgery is no better than exercise, physiotherapy and painkillers for people suffering from osteoarthritis, new Canadian research shows.

Osteoarthritis is the most common form of arthritis; it commonly affects the hips, feet, spine and the large weight bearing joints, such as the hips and knees. As the disease progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day. As the bone surfaces become less well protected by cartilage the patient experiences pain upon weight bearing. Walking and standing become painful as well.About 27 million Americans suffer from pain and stiffness of osteoarthritis, according to the most recent figures.

Arthroscopic knee surgery is a common procedure among people suffering from osteoarthritis. During the surgery, the surgeon makes small incisions in the knee, inserts an arthroscope to visualize the joint and then flushes debris from the knee, or shaves rough areas of cartilage cleansing the joint. About 985,000 Americans had arthroscopic knee surgeries in 2006, according to federal estimates.

The new study was done by researchers at the University of Western Ontario, Canada and involved 178 patients average age 60 who were divided into two groups. Patients in the first group underwent arthroscopic surgery. The others received physical therapy along with medical treatment such as anti-inflammatory drugs and injections designed to reduce pain.

The patients were followed for two years. After this period, the researchers measured the patients’ pain, stiffness and physical function and found no significant difference between the groups. Patients in the surgery group showed greater improvement in the first three months, but the symptoms of osteoarthritis reappeared after six months.

“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,” said lead author of the study Brian Feagan, MD, clinical trials director at the Robarts Research Institute at the University of Western Ontario and a professor of medicine, and epidemiology and biostatistics at the university's Schulich School of Medicine & Dentistry.

The findings support another study made in 2002, which involved patients recruited from the Houston Veterans Affairs Medical Center and which showed no significant improvement in patients undergoing arthroscopic surgery compared to patients having a placebo procedure.

In an editorial accompanying the study in the September 11 issue of the New England Journal of Medicine, Robert Marx, an orthopedic surgeon at the Hospital for Special Surgery in New York, says arthroscopy may not be effective for arthritis alone but “can be beneficial for patients who also have a torn meniscus [the area where the major bones of the leg connect] or floating pieces of cartilage.” It is important to "to individualize decision-making with respect to arthroscopic surgery for patients with osteoarthritis of the knee,” he added.

Instead of undergoing arthroscopic surgery, patients suffering from osteoarthritis should consider alternative treatments. A study led by Siba Raychaudhuri, a faculty member of the University of California, Davis, in the United States and published at the end of July in the journal Arthritis Research & Therapy found that an herbal extract of an Indian Frankincense Salai, commonly found in Madhya Pradesh and Rajasthan, can effectively reduce the symptoms of osteoarthritis. More exactly, the study found patients taking the herbal remedy which consisted in an enriched extract of “Indian Frankincense,” or the herb Boswellia serrata, showed significant improvement in as little as seven days.

The herb has been used for thousands of years in the Indian system of traditional medicine, but the research study published in Arthritis Research & Therapy is the first to prove that an enriched extract of the plant can be used as a successful treatment to reduce the symptoms of osteoarthritis.