Pointlessness of knee surgery for osteoarthritis confirmed again
PainSci summary of Kirkley 2008 ★★★★☆?4-star ratings are for larger and better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
In 2002, Moseley published the results of a fascinating experiment that showed that people who received a fake arthroscopic knee surgery had results just as good as people who received the real surgery for osteoarthritis. Six years later, these findings were fully supported by a Cochrane Collaboration review (Laupattarakasem et al), which concluded that “there is ‘gold’ level evidence that arthoscopic debridement has no benefit.” As if that wasn’t enough, this study piled on and reported the same thing again: “no additional benefit to optimized physical and medical therapy.”
BACKGROUND: The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown.
METHODS: We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic debridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).
RESULTS: Of the 92 patients assigned to surgery, 6 did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean ([+/-]SD) WOMAC score for the surgery group was 874[+/-]624, as compared with 897[+/-]583 for the control group (absolute difference [surgery-group score minus control-group score], -23[+/-]605; 95% confidence interval [CI], -208 to 161; P=0.22 after adjustment for baseline score and grade of severity). The SF-36 Physical Component Summary scores were 37.0[+/-]11.4 and 37.2[+/-]10.6, respectively (absolute difference, -0.2[+/-]11.1; 95% CI, -3.6 to 3.2; P=0.93). Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.
CONCLUSIONS: Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.
- “A controlled trial of arthroscopic surgery for osteoarthritis of the knee,” an article in New England Journal of Medicine, 2002.
- “Arthroscopic debridement for knee osteoarthritis,” an article in Cochrane Database of Systematic Reviews, 2008.
These two articles on PainScience.com cite Kirkley 2008 as a source:
- PS Save Yourself from Patellofemoral Pain Syndrome! — Patellofemoral pain syndrome (aka runner’s knee) explained and discussed in great detail, including every imaginable self-treatment option and all the available scientific evidence
- PS Knee Surgery Sure is Useless! — The New England Journal of Medicine “piles on” with still more evidence that arthroscopic knee surgery for osteoarthritis is about as helpful as a Nerf hammer