Johns Hopkins Health Alerts: Arthritis

* Arthroscopic Surgery for Knee Osteoarthritis: Consensus and
Controversy

Joint debridement and lavage used to be popular treatments for
osteoarthritis (OA) of the knee. Today, there is disagreement about when
-- and when not -- to have these arthroscopic surgeries for knee
osteoarthritis.

Here's our advice.

What are joint debridement and lavage?
****************

* Debridement entails smoothing out damaged cartilage and bone using
tiny instruments passed through a thin, lighted tube with a camera
attached to one end (an arthroscope).
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* Lavage involves washing out any loose tissue or debris from inside the
joint space, through one or two needles or, most commonly, through an
arthroscope.

Surprisingly, however, a 2002 trial of 180 people with knee
osteoarthritis, reported in the New England Journal of Medicine, found
that neither arthroscopic lavage nor a combination of lavage and
debridement worked any better than a "sham" operation that mimicked the
arthroscopic procedure.

Consensus and controversy. The most recent findings come from the
Cochrane Collaboration.
They examined data from seven studies of joint lavage involving almost
600 people and found little evidence that it reduced pain or improved
function, even within a few months of surgery.

In an earlier study, the group reached a similar conclusion about
arthroscopic debridement.
They found that it offered no value for people with painful knee
osteoarthritis due to inflammation or a mechanical cause, such as a
loose body or a tear in the tough cartilage that cushions the knee (the
meniscus).

But other experts and current guidelines from the American Academy of
Orthopaedic Surgeons disagree. They support arthroscopy when magnetic
resonance imaging (MRI) shows a loose body or torn meniscus -- a common
problem in middle-aged and elderly people with osteoarthritis.

Our advice. There is universal agreement that arthroscopic debridement
and lavage are not beneficial for people with knee osteoarthritis and no
mechanical cause of pain. Arthroscopy can be considered, however, if
there is a mechanical problem. Even if there is a mechanical problem,
though, there's no guarantee that it's the source of the pain -- it
could be the osteoarthritis.

Evidence suggests that people who undergo arthroscopic surgery and later
have knee replacement surgery have less satisfactory results than their
counterparts who haven't had arthroscopy.

Consequently, most patients who have osteoarthritis that is severe
enough to warrant knee replacement should avoid arthroscopy if at all
possible, and if surgery becomes necessary, they should proceed directly
to knee replacement.

..
..
Donna G.
..
..
1) Rejoice always, Pray continually, Give thanks in all circumstances,
For this is God's will for you in Christ Jesus. ( I Thessalonians
5:16-18 NIV )

2) ANGELS EXIST, but some times, since they don't all have wings, we
call them FRIENDS......

3) Just because you're in pain, doesn't mean you have to be one!