A controlled trial of arthroscopic surgery for osteoarthritis of the knee.
BACKGROUND
Many patients report symptomatic relief after undergoing arthroscopy of the knee for osteoarthritis, but it is unclear how the procedure achieves this result. We conducted a randomized, placebo-controlled trial to evaluate the efficacy of arthroscopy for osteoarthritis of the knee.


METHODS
A total of 180 patients with osteoarthritis of the knee were randomly assigned to receive arthroscopic débridement, arthroscopic lavage, or placebo surgery. Patients in the placebo group received skin incisions and underwent a simulated débridement without insertion of the arthroscope. Patients and assessors of outcome were blinded to the treatment-group assignment. Outcomes were assessed at multiple points over a 24-month period with the use of five self-reported scores--three on scales for pain and two on scales for function--and one objective test of walking and stair climbing. A total of 165 patients completed the trial.


RESULTS
At no point did either of the intervention groups report less pain or better function than the placebo group. For example, mean (+/-SD) scores on the Knee-Specific Pain Scale (range, 0 to 100, with higher scores indicating more severe pain) were similar in the placebo, lavage, and débridement groups: 48.9+/-21.9, 54.8+/-19.8, and 51.7+/-22.4, respectively, at one year (P=0.14 for the comparison between placebo and lavage; P=0.51 for the comparison between placebo and débridement) and 51.6+/-23.7, 53.7+/-23.7, and 51.4+/-23.2, respectively, at two years (P=0.64 and P=0.96, respectively). Furthermore, the 95 percent confidence intervals for the differences between the placebo group and the intervention groups exclude any clinically meaningful difference.


CONCLUSIONS
In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.
Houston Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX 77030, USA.
J Bruce
JB
Moseley
Kimberly
K
O'Malley
Nancy J
NJ
Petersen
Terri J
TJ
Menke
Baruch A
BA
Brody
David H
DH
Kuykendall
John C
JC
Hollingsworth
Carol M
CM
Ashton
Nelda P
NP
Wray
D000368:Aged; D001182:Arthroscopy / Q000379:methods; D003646:Debridement; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D010146:Pain / Q000601:surgery; D015990:Placebo Effect; D007507:Therapeutic Irrigation; D017211:Treatment Failure; D016138:Walking