Osteoarthritis

Arthroscopy for degenerative knees doesn’t stand up


The findings of a recent study on the use of arthroscopy in knee osteoarthritis removes one of the obstacles to gaining a real reduction in procedure rates, an orthopaedic surgeon says.

 The research by the Finnish FIDELITY group found that the partial removal of a degenerative torn meniscus does not reduce or alleviate mechanical symptoms of knee osteoarthritis.

The findings build on their previous multicenter trial published in the NEJM that found arthroscopic partial meniscectomy was not superior to sham surgery in people with a degenerative medial meniscus tear.

“Based on these results we can state that the partial removal of a degenerative torn meniscus does not reduce or alleviate mechanical symptoms when compared with sham surgery,” said lead author Teppo Järvinen, professor of orthopaedics and traumatology at the University of Helsinki and HUCS.

According to Ian Harris, a professor of orthopaedic surgery at the UNSW, the results remove one of the current obstacles to gaining a real reduction in knee arthroscopy rates: the belief that mechanical symptoms can be relieved by arthroscopic partial meniscectomy.

The majority of knee arthroscopies in Australia are performed in patients aged over 50, most of whom will have degenerative changes, he told the limbic.

“The highest quality evidence available tells us that this procedure offers no significant benefit over placebo surgery for this population.

“It is now up to the orthopaedic surgical community to take this evidence on board and change practice accordingly” he said.

In the current study published in the Annals of Internal Medicine 146 patients who participated in the original FIDELITY study and had knee pain considered to be attributable to a tear of the medial meniscus underwent diagnostic keyhole surgery.

If a torn meniscus was found they were randomised to undergo either a partial meniscectomy (70 patients) or sham surgery (76 patients).

Overall 32 patients (46%) in the partial meniscectomy group and 37 (49%) in the placebo group initially (before surgery) reported sensations of mechanical symptoms.

The research team conducted a follow-up survey two, six and twelve months from the procedure.

From the total of 146 patients, 34 (49%) from the partial meniscectomy group and 33 (43%) from the placebo group reported a mechanical symptom at some point during the follow-up process.

Of the 69 patients who had mechanical symptoms at the outset, 23 (72%) of the partial meniscectomy group and 22 (59%) of the placebo group reported still experiencing mechanical symptoms at some point during the follow-up process.

The mechanical symptoms were alleviated for the full duration of the follow-up process for 9 patients (28%) who underwent a partial meniscectomy and 15 patients (41%) who underwent sham surgery.

 

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