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Is Arthroscopic Surgery Effective for Knee Osteoarthritis?

A sham surgical procedure, arthroscopic lavage, and lavage plus débridement all worked equally well for relieving pain caused by knee osteoarthritis.

Arthroscopic lavage and débridement are used frequently to treat patients with knee osteoarthritis whose symptoms are refractory to medication. However, these procedures have not been subjected to rigorously controlled trials; indeed, the 2001 edition of Harrison's Principles of Internal Medicine notes that such procedures have a large placebo effect and that studies with a sham-procedure control group have not yet been reported. Now, we have such a study.

Researchers at the Houston Veterans Affairs Hospital and Baylor College of Medicine randomized 180 patients with knee osteoarthritis and moderate pain (despite maximal medical therapy) to 3 groups: arthroscopic lavage; arthroscopic lavage plus débridement; or a placebo procedure, in which 3 incisions for arthroscopy were made, but no instruments entered the joint. Patients and investigators who assessed outcomes were blinded to treatment group. On serial assessments during a 2-year follow-up period, there were no significant differences between the groups on scores for pain or physical functioning.

Comment: These results strongly suggest that arthroscopic lavage and débridement are ineffective for most patients with knee osteoarthritis. Using this study as an example, essayists in this issue of the New England Journal of Medicine discuss the ethics of placebo surgery; they conclude that placebo-surgery controls are permissible as long as risks are minimized, the research question is important, and subjects provide meaningful informed consent.

— Allan S. Brett, MD

Published in Journal Watch General Medicine July 16, 2002

Citation(s):

Moseley JB et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002 Jul 11; 347:81-8.

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• Medline abstract (Free)

Horng S and Miller FG. Is placebo surgery unethical? N Engl J Med 2002 Jul 11; 347:137-9.

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• Medline abstract (Free)