Popular Knee Surgery May Be Useless
Experts Say Arthroscopy for Arthritis Is a Waste of Time and Money
The surgery involves the insertion of an arthroscope into the knee and either flushing the joint with a saline solution or flushing and scraping the knee joint. Both procedures are done to remove debris and inflammatory enzymes, but there is no indication that they slow the progression of arthritis.
In this study, 180 osteoarthritis patients treated at the Houston VA Medical Center were randomly assigned to receive the flushing procedure alone, the flushing plus scraping procedure, or the placebo surgery. All the patients understood at the outset that there was a one-in-three chance that they would receive the placebo surgery, and none knew which procedure they had gotten.
Medical observers who were also unaware of which procedure the patients received assessed their ability to perform various functions such as walking and climbing stairs.
Lead researcher J. Bruce Moseley, MD, who performed all 180 surgeries, tells WebMD that he has long questioned the value of using arthroscopic surgery to treat people with osteoarthritis. This study, he says, is the best evidence yet that the procedure is not useful. Moseley is a clinical associate professor of orthopaedic surgery at Baylor and is team surgeon for the Houston Rockets and the Houston Comets.
Osteoarthritis expert and rheumatologist David T. Felson, MD, says the study offers very strong evidence that that the surgery is of little value in this group of patients. He agrees that persuading orthopaedic surgeons not to do it may be difficult.
"There is a large community of surgeons who do this operation, and what this study is telling them is that what they are doing is worthless," Felson tells WebMD. "What I have seen when I refer patients is that surgeons tend to use this as a way to delay total knee replacement. But I don't think that is in the patient's best interest."