One of the most common surgical procedures to treat osteoarthritis – arthroscopic knee surgery – does not provide a better outcome than medication or physical therapy, suggests a new study in the New England Journal of Medicine.
"We concluded that the procedure is not useful for patients with moderate to severe osteoarthritis," researchers at the University of Western Ontario in Canada said. They studied 178 men and women suffering from moderate to severe arthritis in their knees. Half of them had arthroscopic surgery and the rest got only physical activity and took medications to relieve the pain, such as anti-inflammatory drugs and injections.
After a period of two years, researchers found no significant difference between the groups: those who underwent the surgery fared no better than those who had physical activity and took medication. Both groups improved, reporting less pain and more mobility.
The result is backed by another study. In 2002, a team of researchers found that operations were no better than a sham procedure for arthritis. But the 2002 study was criticized as flawed; all the operations were done by one surgeon and the subjects were all men and tended to be older than the typical patient. But Canadian researchers said their study is different because it involved both men and women and patients who were 60 years old on average, which is more typical.
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 OA 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, including walking and standing.
Arthroscopic surgery is a common procedure among people suffering from osteoarthritis. During the procedure, the surgeon makes a small incision in the knee, inserts a device to visualize the joint and then flushes debris from the knee, or shaves rough areas of cartilage cleansing the joint. According to federal estimates, about 985,000 Americans had arthroscopic knee surgeries in 2006. About 20% of the 900,000 arthroscopic knee surgeries performed annually in North America are done as treatment for osteoarthritis, said the study’s co-author Dr. Bob Litchfield, the medical director of the Fowler Kennedy Sport Medicine Clinic at London Health Sciences Centre in Ontario, Canada.
"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.
Another study published in the journal Arthritis Research & Therapy, found patients taking an herbal remedy which consisted in an enriched extract of "Indian Frankincense," or the herb Boswellia serrata, showed significant improvement of their condition in as little as seven days. The study led by an Indian scientist found that an herbal extract of an Indian Frankincense Salai, commonly found in Madhya Pradesh and Rajasthan, can effectively reduce the symptoms of osteoarthritis.
However, experts agree that knee replacement surgery is an option for those with serious arthritis. But the incidence of adverse side effects associated with surgery, or with medications has created a great interest in the search for more effective and safe alternative treatments.
