Sham Arthroscopic Knee Surgery for OA
This paper was published in the New England Journal of Medicine, which is regarded as a very prestigious journal. Although it is now 14 years old, it is soooo fascinating that I think the study is worth re-mentioning.
What do you tell patients who ask you about surgery for their mild to moderate knee OA?
You tell them that in one study, patients with mild to moderate knee arthritis were randomly allocated to one of two groups. One group of patients received real arthroscopic surgery where the surgeons went in and cleaned the knee joint (arthroscopic debridement & lavage).
The other group of patients received a fake surgery where the surgeons simply cut the skin and pretended that they went in and cleaned the knee joint, when in fact they didn’t do anything to the knee joint.
Researchers who followed the patients for 2 years were blinded, meaning that they had no idea which patients got the real surgery and which patients got the sham surgery.
They found absolutely no differences in pain, ability to walk and climb stairs between the two groups. Both groups were identical at 1 month, 3 months, 1 year and even 2 years after the surgery.
“…the billions of dollars spent on such procedures annually might be put to better use.” Moseley JB et al 2002
Conclusion in a nutshell: If you have mild to moderate knee OA, stick to physiotherapy and exercising. The benefits of arthroscopic lavage seem to be primarily placebo! If PT fails, only then consider cortisone or surgery.
Reference: Moseley JB et al A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002 Jul 11;347(2):81-8.