Knee arthritis and arthroscopy

Arthroscopic surgery for knee osteoarthritis is an ineffective and costly treatment. Yet the operation is still performed. I was reminded of this just recently when a patient whose arthritic knee we’d been managing without surgery, went to a nearby city and had a knee arthroscopy.

In my early surgical training, arthroscopic debridement, or “cleaning out” of the knee, was a standard treatment for arthritis. What was cleaned out was never clear, as the arthritis was still there. Many patients had short term benefits, but symptoms would inevitably return. Some patients came back for regular “cleanouts”, much like an annual car service of oil and filter changes, and we’ll check the brake pads too.

Moseley and colleagues1 published the first study questioning the effectiveness of arthroscopy in the treatment of knee arthritis 18 years ago. The study compared traditional arthroscopic surgical debridement with sham surgery. As the name suggests, the surgeon made small cuts in the knee but didn’t perform an actual arthroscopy. The results of the study showed that there was no difference between the people who had arthroscopic surgery and those that had a sham procedure, with the conclusion that arthroscopic surgery is ineffective treatment for osteoarthritis of the knee.

As you could imagine, this article caused quite a stir amongst orthopaedic surgeons. Many surgeons criticised the study’s methodology, and hence disagreed with the study’s results. However, since Moseley’s original article, there have been many similar studies published, virtually all having the same conclusion: that arthroscopic debridement for knee osteoarthritis is not beneficial.

 A person may still require an arthroscopy of an arthritic knee, but for specific reasons. These reasons include washing out a knee infection and removing a symptomatic loose body floating around the knee. But these are relatively uncommon reasons.

Knee arthroscopy is still a procedure performed regularly in non-arthritic knees. Fortunately, arthroscopic surgery remains a very low-risk procedure. “Low-risk” but not “no risk”. Therefore, if a person with arthritis has a knee arthroscopy without a valid reason, they are exposed to the risks of surgery without any of the benefits.

  1. Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med2002; 347: 81-88