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Previous Volume 347:81-88 July 11, 2002 Number 2 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Felson, D. T. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by Horng, S. PubMed Citation

ABSTRACT

Background Many patients report symptomatic relief after undergoing arthroscopy of the knee for osteoarthritis, but it is unclear how the procedure achieves this result. We conducted a randomized, placebo-controlled trial to evaluate the efficacy of arthroscopy for osteoarthritis of the knee.

Methods A total of 180 patients with osteoarthritis of the knee were randomly assigned to receive arthroscopic débridement, arthroscopic lavage, or placebo surgery. Patients in the placebo group received skin incisions and underwent a simulated débridement without insertion of the arthroscope. Patients and assessors of outcome were blinded to the treatment-group assignment. Outcomes were assessed at multiple points over a 24-month period with the use of five self-reported scores — three on scales for pain and two on scales for function — and one objective test of walking and stair climbing. A total of 165 patients completed the trial.

Results At no point did either of the intervention groups report less pain or better function than the placebo group. For example, mean (±SD) scores on the Knee-Specific Pain Scale (range, 0 to 100, with higher scores indicating more severe pain) were similar in the placebo, lavage, and débridement groups: 48.9±21.9, 54.8±19.8, and 51.7±22.4, respectively, at one year (P=0.14 for the comparison between placebo and lavage; P=0.51 for the comparison between placebo and débridement) and 51.6±23.7, 53.7±23.7, and 51.4±23.2, respectively, at two years (P=0.64 and P=0.96, respectively). Furthermore, the 95 percent confidence intervals for the differences between the placebo group and the intervention groups exclude any clinically meaningful difference.

Conclusions In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.

Source Information

From the Houston Veterans Affairs Medical Center (J.B.M., K.O., N.J.P., T.J.M., D.H.K., C.M.A., N.P.W.); the Department of Orthopedic Surgery (J.B.M.), the Department of Medicine, Section of Health Services Research (K.O., N.J.P., T.J.M., C.M.A., N.P.W.), and the Center for Medical Ethics and Health Policy (B.A.B.), Baylor College of Medicine; and International Survey Research (D.H.K.) — all in Houston; and the Laguna Honda Hospital, San Francisco (J.C.H.).

Address reprint requests to Dr. Wray at the Section of Health Services Research, Baylor College of Medicine, 2002 Holcombe Blvd. (M.R. 152), Houston, TX 77030, or at nwray{at}bcm.tmc.edu.

Full Text of this Article

Related Letters:

Arthroscopic Surgery for Osteoarthritis of the Knee
Jackson R. W., Ewing W., Ewing J. W., Chambers K. G., Schulzer M., Blacher R. S., Morse L. J., Wray N. P., Moseley J. B., O'Malley K., Horng S., Miller F. G.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:1717-1719, Nov 21, 2002. Correspondence

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