title: Arthroscopy for mechanical symptoms in osteoarthritis: a cost-effective procedure.
abstract: OBJECTIVE
  The place of knee arthroscopy as a therapeutic option for osteoarthritis (OA) has been the subject of some debate. The hypothesis for this study was that arthroscopic debridement is beneficial in patients with OA who have significant mechanical symptoms.
  
  
  METHODS
  Forty-three patients with radiological OA on plain radiographs and mechanical symptoms were prospectively followed. No further imaging was obtained. They were assessed pre- and postoperatively with an Oxford Knee Score (OKS) and pain visual analogue score (VAS). Postoperative patient satisfaction was measured with a VAS. A cost-benefit analysis was performed using a transformed OKS to generate a quality-adjusted life year (QALY) measurement.
  
  
  RESULTS
  At a mean of 1.5 years, seven patients (16 %) had undergone total knee arthroplasty at a mean of 8.2 months postarthroscopy. For the remaining 35 patients, there were significant improvements in pain (median 7-5, p < 0.05) and OKS (median 24-36.5, p < 0.05). Satisfaction was a median 6.2 for all patients. The mean calculated EQ-5D improved from 0.43 (SD 0.16) to 0.79 (SD 0.23), which gave a gain of 0.52 QALYs in the study period. This generated a cost per QALY of £2,088, well below the threshold of £30,000 quoted by the UK National Institute for Health and Care Excellence as demonstration of cost-effective treatment.
  
  
  CONCLUSIONS
  This prospective study demonstrates that although not universally effective, arthroscopic debridement for patients with knee OA and mechanical symptoms can result in significant improvements in pain and function. The procedure gave good patient satisfaction, and even at an early follow-up period proves to be cost-effective.
  
  
  METHODS
  IV.
authors.affiliation: Epsom General Hospital, Dorking Road, Epsom, Surrey, KT18 7EG, UK. drhutt@hotmail.com.|, 3535 Av Papineau, Apt 406, Montreal, QC, H2K 4J9, Canada. drhutt@hotmail.com.
authors.forename: Jonathan R B
authors.initials: JR
authors.lastname: Hutt
authors.affiliation: Epsom General Hospital, Dorking Road, Epsom, Surrey, KT18 7EG, UK.
authors.forename: Johnathan
authors.initials: J
authors.lastname: Craik
authors.affiliation: Epsom General Hospital, Dorking Road, Epsom, Surrey, KT18 7EG, UK.
authors.forename: Joideep
authors.initials: J
authors.lastname: Phadnis
authors.affiliation: Epsom General Hospital, Dorking Road, Epsom, Surrey, KT18 7EG, UK.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Cobb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000191:economics; D001696:Biomechanical Phenomena; D003362:Cost-Benefit Analysis; D003646:Debridement; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome
keywords: Arthroscopy; Debridement; Knee; Osteoarthritis
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