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Pointlessness of knee surgery for osteoarthritis confirmed again

PainSci » bibliography » Kirkley et al 2008
Tags: knee, arthritis, surgery, counter-intuitive, leg, limbs, pain problems, aging, treatment

Two articles on PainSci cite Kirkley 2008: 1. The Complete Guide to Patellofemoral Pain Syndrome2. Knee Debridement is a Completely Ineffective Procedure

PainSci commentary on Kirkley 2008: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

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.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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.

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This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:

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