A study in the New England Journal of
Medicine shows that arthroscopic knee surgery does not provide better outcomes
for patients with moderate to severe osteoarthritis than medication or physical
therapy. The result is backed by another study. In 2002, a team of researchers
found that the effect arthroscopy surgery had on patients was the same with the
effect of physical therapy and medication. The 2002 study was dismissed by the medical
community and arthroscopic surgery is s still the most common surgical
procedure to treat osteoarthritis.
During arthroscopy, a surgeon examines and
repairs an injured or diseased joint using an optical instrument called
arthroscope. A video camera attached to the arthroscope relays the view from
within the joint to a video monitor. Doctors use this type of procedure to
treat a variety of joint conditions, most commonly those affecting the knee,
shoulder, elbow, ankle, hip and wrist.
The study published in the Sep. 11th issue
of the New England Journal of Medicine involved 178 men and women at an average
age of 60 who had moderate to severe osteoarthritis of the knee. They were
followed for a period of two years. 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. All patients reported improvement
of their condition, but the surgery did not provide any additional benefit
compared to alternative treatments.
“The 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 study co-author Dr. Brian Feagan, Clinical Trials Director at
the Robarts Research Institute and professor of Schulich School
of Medicine & Dentistry at The University of Western Ontario.
Treatments like physical therapy and
medications such as ibuprofen or acetaminophen, disease-modifying
anti-rheumatic drugs, and corticosteroids may provide long-term relief for
arthritis pain.
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. During
the knee replacement surgery, also referred to as total knee arthroplasty, a
surgeon cuts away the damaged bone and cartilage from the patient’s thighbone,
shinbone and kneecap and replaces it with an artificial joint (prosthesis) made
of metal alloys, high-grade plastics and polymers. The surgery can restore
function in severely diseased knee joints.
An estimated 27 U.S. residents suffer from
osteoarthritis, a main cause of disability. 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. 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.
Brian Feagan, director of the Robarts
Clinical Trials at the University of Western Ontario in London, Canada,
and colleagues concluded that “the procedure is not useful for patients with
moderate to severe osteoarthritis.”
