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Posts Tagged ‘arthroscopic’

arthroscopy

arthroscopy

In a recent policy article, health insurance giant Aetna considers arthroscopic debridement and lavage for osteoarthritis of the knee experimental and investigational because its effectiveness has not been established.

The only people Aetna considers arthroscopic debridement and lavage medically necessary are for those with mild to moderate osteoarthritis who have loose bodies or meniscal tears in their knees.

This means Aetna is reading the literature.  They based their policy on 40 different references from medical journals and scholarly articles.  Arthroscopic debridement and lavage is not an effective treatment option for many people with knee osteoarthritis.



meniscectomy

meniscectomy

Recommendation 19 – Partial meniscectomy is an option for patients with knee osteoarthritis.  These patients must also have symptoms indicating a torn meniscus and / or a loose body in their knee joint.

There aren’t any published studies that confirm this recommendation but the expert opinion of the research team concludes that if you have a torn meniscus and knee osteoarthritis, it makes sense to have the tear or loose material removed by arthroscopy.



Knee Arthroscopy

Knee Arthroscopy

This post is one of a series of posts about the American Academy of Orthopedic Surgeons’ (AAOS) Knee Osteoarthritis TreatmentGuideline.

Recommendation 18 – The AAOS does not recommend arthroscopic debridement and lavage in patients with knee oa.

Since the North American Arthroscopy Association helped fund the AAOS Treatment Guideline, this recommendation is a big deal.  This is orthopedic surgeons telling other orthopedic surgeons that one of their bread-and-butter surgeries doesn’t work.

The research team concluded that arthroscopic debridement has no significant benefit for knee osteoarthritis.  Wow.




This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

knee surgery

arthroscopic knee surgery

Recommendation XXIV

Arthroscopic debridement and lavage for knee osteoarthritis is controversial.

3 out of 3 treatment guidelines recommend arthroscopic debridement and lavage as a treatment option for knee OA but some studies have demonstrated symptomatic pain relief can be attributed to a placebo effect.  Controversy regarding the efficacy and indications for this treatment option continues.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 60%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162


arthroscopic knee surgery

arthroscopic knee surgery

The Department of Veteran Affairs in conjunction with Baylor University in Houston reports that patients with knee osteoarthritis who underwent a placebo (or fake) surgery were just as likely to report pain relief as those who underwent an actual arthroscopic surgery!

The lead investigator of the study published in the New England Journal of Medicine, Dr. Nelda Wray said, “The fact that the effectiveness of arthroscopic lavage or debridement in patients with osteoarthritis of the knee is no greater than that of placebo surgery makes us question whether the one billion plus dollars spent on these procedures might not be put to better use.”

The study divided 180 patients into three groups.  One group received debridement – where damaged cartilage is cut out.  The second group received lavage, where bad cartilage is washed out of the knee.  And the third group received two small incisions but no actual surgery.

All three groups reported moderate improvements in pain and function!

Dr. Wray went on to say that, ” We have shown that the entire driving force behind this billion dollar industry is the placebo effect.  The health care industry should rethink how to test whether surgical procedures, done purely for the relief of subjective symptoms, are more efficacious than a placebo.”

Nelda P. Wray, M.D A Controlled Trial of Arthroscopic Surgery of the Knee.  New England Journal of Medicine, July 11, 2002. Volume 347:81-88



knee painA study on arthroscopic surgery to treat knee OA was published in the New England Journal of Medicine.  The study reported “At no point did either of the intervention groups report less pain or better function than the placebo group.  Because there is no confirmed usefulness for these surgeries many agencies are reconsidering paying for a surgery which seems to create risks with no benefit”.

Further, the American Academy of Orthopedic Surgeons released in their 2008 Treatment Guideline for Knee Osteoarthritis that they could not recommend arthroscopic surgery as an effective treatment option.

The New England Journal of Medicine and the American Academy of Orthopedic Surgeons both agree that arthroscopic surgery may not be an effective treatment for your knee pain.

Have you ever considered trying a knee brace to treat your OA?  Bio-mechanical knee braces are clinically proven to decrease pain and increase function in arthritic knees.  They are commonly called Unloading Braces or Off-Loading braces.  Nobody has ever died from wearing knee braces.