A randomized trial of arthroscopic surgery for osteoarthritis of the knee.
BACKGROUND
The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown.


METHODS
We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic débridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).


RESULTS
Of the 92 patients assigned to surgery, 6 did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean (+/-SD) WOMAC score for the surgery group was 874+/-624, as compared with 897+/-583 for the control group (absolute difference [surgery-group score minus control-group score], -23+/-605; 95% confidence interval [CI], -208 to 161; P=0.22 after adjustment for baseline score and grade of severity). The SF-36 Physical Component Summary scores were 37.0+/-11.4 and 37.2+/-10.6, respectively (absolute difference, -0.2+/-11.1; 95% CI, -3.6 to 3.2; P=0.93). Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.


CONCLUSIONS
Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy. (ClinicalTrials.gov number, NCT00158431.)
Kirkley
Alexandra
A
Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON, Canada.
Birmingham
Trevor B
TB
Litchfield
Robert B
RB
Giffin
J Robert
JR
Willits
Kevin R
KR
Wong
Cindy J
CJ
Feagan
Brian G
BG
Donner
Allan
A
Griffin
Sharon H
SH
D'Ascanio
Linda M
LM
Pope
Janet E
JE
Fowler
Peter J
PJ
D000082:Acetaminophen / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001182:Arthroscopy; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005944:Glucosamine / Q000627:therapeutic use; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D026741:Physical Therapy Modalities; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D006820:Hyaluronic Acid; D002809:Chondroitin Sulfates; D005944:Glucosamine