Arthroscopic Surgery for Knee Arthritis

Will Knee Arthroscopy Help With Early Arthritis?

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Arthroscopic surgery of the knee is one of the most common surgical procedures.  Many orthopedic surgeons perform a variety of surgical procedures for knee problems.  One of the most common knee problems is osteoarthritis, or wear-and-tear arthritis of the knee.  Sometimes surgeons will try a minimally invasive knee arthroscopy to try to delay having to perform knee replacement surgery.  These 'clean-up' procedures can all your surgeon to smooth down wear, clean up tears, and remove any debris from the knee joint.

However, over the last decade, there has been a significant controversy about the effectiveness of knee arthroscopy for the treatment of knee arthritis.  Some medical reports have gone on to say that a knee arthroscopy is no better than 'sham surgery,' or placebo, for treatment of early arthritis of the knee.  But that's not the whole story.

Is It Sham Surgery?

This controversy stems from an article published in the New England Journal of Medicine that evaluated the treatment of arthritis of the knee joint in patients at a VA hospital in Houston, Texas. The study separated 180 patients into one of three groups. One group received an arthroscopic debridement, where the knee was 'cleaned up'; another group received a knee wash-out, or lavage, with saline; and the final group had no procedure--a 'sham' surgery. The results showed that there was no difference in outcome between these groups.

At first glance, it would seem this proves that knee arthroscopy shouldn't ever be performed for people with early arthritis of the knee.

  Why take the risk of arthroscopic knee surgery if there is no additional benefit. The benefit of knee arthroscopy in treating cartilage tears, ACL injuries, and other specific conditions has been shown repeatedly to be outstanding. Surgical decisions must take into account careful consideration of so-called operative indications.

When surgery is done for the right reasons, it is usually effective.

The Reason Why Knee Scopes Work

As stated, knee arthroscopy is effective for many problems.  The common theme of these problems is that they all cause "mechanical" symptoms. Mechanical symptoms are problems such as a catching sensation, a giving way, or painful popping. These symptoms can be due to impediments to normal knee function. Knee arthroscopy to treat knee pain, with none of these other symptoms, can be beneficial, but it is much less predictable.

The study condemning knee arthroscopy for the treatment of arthritis did not differentiate patients who simply had pain with those that had these mechanical symptoms.  Therefore, most surgeons at this point agree that in the setting of early arthritis, knee arthroscopy can be considered as a treatment, but patients should be carefully selected.  Not every patient with arthritis is likely to improve with an arthroscopic surgery, but some patients with some mild arthritis, and these mechanical symptoms, might be good candidates for this procedure.

Bottom Line: Best Treatment

Knee arthritis treatment is most beneficial in the mildest and most advanced stages of the condition. Anti-inflammatory medications, physical therapy, steroid injections, knee braces, and other noninvasive treatments are all reasonable options for early stages of arthritis.  Knee replacement is an excellent treatment for advanced arthritis. The problem is treatment for people stuck in the middle. While knee arthroscopy is unlikely to benefit most patients with knee arthritis, there does seem to be a subset of patients who may find relief.

Sources:

Moseley JB, et al. "A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee" N Engl J Med 2002; 347:81-88.

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