OA of the knee? Try Meds and PT

September 15th, 2008 | Sources: Medical News Today, NEJM, NY Times

A randomized controlled trial has revealed that for patients with osteoarthritis (OA) of the knee, arthroscopic surgery offers no benefit versus conservative therapy.

The arthroscopic intervention tested in this study is lavage and debridement. Conservative therapy included anti-inflammatory medications and physical therapy.

The investigators randomized 178 patients with moderate to severe OA. They assessed patient outcomes using two symptom-based questionnaires-the Western Ontario and McMaster Universities Osteoarthritis Index and the Short Form-36 Physical Component summary score. When investigators compared scores on these tests for the treatment and control groups at the end of two years, they found no significant difference. In particular, there was no difference in pain or activity level. Score comparisons at earlier time intervals also showed no difference.

The authors concluded that “the resources currently allocated towards arthroscopic surgery for osteoarthritis would be better directed elsewhere.”

Interestingly, Medicare stopped paying for the procedure in 2003 after an earlier study had come to the same conclusion, despite protests from many surgeons who felt the trial design was flawed. It is not clear how many arthroscopic surgeries for OA had been done between then and now (and presumably billed for using a reimbursable procedure code), but the number is probably in the hundreds of thousands per year.


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