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Surgery for osteoarthritis of knee found ineffective

HOUSTON, TEXAS. Osteoarthritis of the knee affects about 12 per cent of people aged 65 years or older. When medication fails to control the pain characteristic of the condition surgery is often recommended. The procedure involves the insertion of several large catheters (rigid tubes) into the knee. Through these tubes the surgeon washes out the inside of the knee with a saline solution (lavage) and, in many cases, also scrapes off rough cartilage and smoothes off the bony parts of the knee (debridement). The main purpose of the procedure is to remove rough spots and debris from the knee joint so as to prevent synovitis (inflammation of the membrane lining a joint capsule). It is estimated that more than 650,000 knee surgeries for osteoarthritis are preformed every year in the United States at a cost of over $3 billion. This despite the fact that there is no evidence that the procedure cures or halts osteoarthritis.

Medical researchers at the Houston Veterans Affairs Medical Center have just released the results of a clinical trial aimed at determining whether lavage and debridement are effective in reducing the pain of knee osteoarthritis. The trial involved 180 men with osteoarthritis of the knee who were assigned to receive either lavage (with 10 liters of saline solution), lavage and debridement or a placebo treatment. In the placebo treatment the patients were sedated and incisions were made in the knee, but no catheters were actually inserted. The patients were followed for two years and evaluated periodically in regard to knee pain and their ability to walk and bend the affected knee. At no point during the study was there any indication that the actual surgical interventions (lavage and debridement) were of any greater benefit than the placebo treatment. All three treatments reduced knee pain slightly, but had no significant effect on the actual functioning of the knee. The researchers conclude that the billions of dollars sent on knee surgery for osteoarthritis might be put to better use.
Moseley, J. Bruce, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine, Vol. 347, July 11, 2002, pp. 81-88
Felson, David T. and Joseph Buckwalter. Debridement and lavage for osteoarthritis of the knee. New England Journal of Medicine, Vol. 347, July 11, 2002, pp. 132-33 (editorial)

Editor's comment: Glucosamine sulfate and chondroitin sulfate have been found effective in the treatment of osteoarthritis of the knee as has therapy using leeches applied to the knee.

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