Popular surgery provides no relief for osteoarthritis of the knee

A landmark study conducted at The University of Western Ontario and Lawson Health Research Institute shows that a routinely practiced knee surgery is ineffective at reducing joint pain or improving joint function for sufferers of osteoarthritis. The study appears in the September 11th New England Journal of Medicine.

"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," says study co-author Dr. Brian Feagan, Clinical Trials Director at the Robarts Research Institute at Western, and a professor in the Departments of Medicine, and Epidemiology and Biostatistics at Western's Schulich School of Medicine & Dentistry.

Arthroscopic surgery is widely accepted as an effective treatment for osteoarthritis of the knee. It's a minimally invasive surgical procedure involving insertion of an arthroscope and other instruments into the joint through small incisions in order to remove cartilage fragments and smooth the joint surfaces. Osteoarthritis is the most common form of arthritis affecting one in ten Canadians, and 27 million Americans.

The study was designed by the late Sandy Kirkley, an orthopaedic surgeon specializing in arthroscopic surgery. It was coordinated by the Clinical Trials Group of Robarts Research Institute and conducted by orthopaedic surgeons at the Fowler Kennedy Sport Medicine Clinic at London Health Sciences Centre (LHSC). The research team also included rheumatologists and physiotherapists.

Running from 1999 to 2007, the study treated 178 London-area men and women with an average age of 60. All study participants received physical therapy as well as medications such as ibuprofen or acetaminophen, but 86 of the patients also received surgery consisting of lavage and arthroscopic debridement at LHSC. At several time intervals post-treatment, the researchers found both patient groups experienced comparable improvements in joint pain, stiffness, and function, but surgery provided no additional benefit.

Orthopaedic surgeon and study co-author Dr. Bob Litchfield emphasizes this study addresses only arthritis-related knee problems. "Although this study did not show a significant therapeutic benefit of arthroscopic debridement in this patient population, knee arthroscopy is still beneficial in many other conditions affecting the knee, such as meniscal repair and resection, and ligament reconstruction." Litchfield is the Medical Director of the Fowler Kennedy Sport Medicine Clinic. He's also a professor in the Department of Surgery at Schulich Medicine & Dentistry and a scientist with the Lawson Health Research Institute. "As surgeons, we need to know when things are working and when they're not. If this particular technique is not working for this subgroup of patients, we better come up with something else that does."

A 2002 study demonstrating similar results to this study was broadly dismissed by the medical community, and arthroscopic surgery of the knee remains a common treatment for joint pain and stiffness. But in this latest study the researchers conclude "based on the available evidence, we believe that the resources currently allocated towards arthroscopic surgery for osteoarthritis would be better directed elsewhere." In 2006/2007, Ontario Health Insurance Plan (OHIP) spent $7.9 million on this procedure alone.

Funding for this study was provided by the Canadian Institutes of Health Research.
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A pdf of the study, interviews with the co-authors, and study patient Steve Studenny who had surgery, and video of arthroscopic surgery and physiotherapy can be downloaded off the internet at:

www.schulich.uwo.ca/netstorage

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