WASHINGTON – Arthroscopic surgery for osteoarthritis of the knee has been called into question by researchers from the Department of Veterans Affairs (VA).
"This is the latest example of VA researchers benefiting all Americans, not just veterans," said Secretary of Veterans Affairs Anthony J. Principi. "I am very proud of the leadership role our researchers continue to play in improving health care."
The research found that patients who underwent "placebo" arthroscopic surgery for osteoarthritis of the knee were just as likely to report pain relief as those who received the real procedure. This is one of the most common surgical procedures for osteoarthritis of the knee.
The research was done by VA and the Baylor College of Medicine in Houston. The results were published in the July 11 New England Journal of Medicine.
In the study, 180 patients with knee pain were randomly divided into three groups. One group received surgery in which worn, torn, or loose cartilage was cut away and removed with the aid of a pencil-thin viewing tube called an arthroscope. The second group underwent arthroscopic lavage, in which the bad cartilage was flushed out. The third group underwent simulated arthroscopic surgery in which small incisions were made, but no instruments were inserted and no cartilage removed.
All patients were aware at the beginning of the study that some would not receive actual surgery.
During two years of follow-up exams, patients in all three groups reported moderate improvements in pain and ability to function. However, patients receiving "placebo" surgery reported the same decrease in pain and improvement in function as the other two groups. In fact, the placebo patients reported better outcomes at certain points during follow-up.
"These VA research results cast doubt on the benefit of this common procedure," said Dr. Jack Feussner, chief VA research and development officer. "The results have implications for the quality, safety, and costs of medcial care, for VA and the rest of the nation."
Osteoarthritis, a degenerative joint disease, is the most common form of arthritis, and typically occurs in the knee. Symptoms include pain, stiffness, and inflammation. Treatment typically involves pain-relieving medicine and anti-inflammatory drugs, along with heat-therapy and exercise. When these fail, surgery is often recommended.
In the United States, it is estimated that more than $3 billion is spent annually on 650,000 arthroscopic procedures of the knee, many for arthritis. An individual procedure typically costs $5,000.
