A randomized trial of arthroscopic surgery for osteoarthritis of the knee
- PMID: 18784099
- DOI: 10.1056/NEJMoa0708333
A randomized trial of arthroscopic surgery for osteoarthritis of the knee
Erratum in
- N Engl J Med. 2009 Nov 12;361(20):2004
Abstract
Background: The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown.
Methods: We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic débridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).
Results: Of the 92 patients assigned to surgery, 6 did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean (+/-SD) WOMAC score for the surgery group was 874+/-624, as compared with 897+/-583 for the control group (absolute difference [surgery-group score minus control-group score], -23+/-605; 95% confidence interval [CI], -208 to 161; P=0.22 after adjustment for baseline score and grade of severity). The SF-36 Physical Component Summary scores were 37.0+/-11.4 and 37.2+/-10.6, respectively (absolute difference, -0.2+/-11.1; 95% CI, -3.6 to 3.2; P=0.93). Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.
Conclusions: Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy. (ClinicalTrials.gov number, NCT00158431.)
2008 Massachusetts Medical Society
Comment in
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Arthroscopic surgery for osteoarthritis of the knee?N Engl J Med. 2008 Sep 11;359(11):1169-70. doi: 10.1056/NEJMe0804450. N Engl J Med. 2008. PMID: 18784107 No abstract available.
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[zur Studie von Kirkley et al. "A randomized trial of arthroscopic surgery for osteoarthritis of the knee"].Praxis (Bern 1994). 2008 Dec 17;97(25):1346. doi: 10.1024/1661-8157.97.25.1346. Praxis (Bern 1994). 2008. PMID: 19085845 German. No abstract available.
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[zur Studie von Kirkley et al. "A randomized trial of arthroscopic surgery for osteoarthritis of the knee"].Praxis (Bern 1994). 2008 Dec 17;97(25):1347. doi: 10.1024/1661-8157.97.25.1347. Praxis (Bern 1994). 2008. PMID: 19085846 German. No abstract available.
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ACP Journal Club. Arthroscopic surgery added no benefit to optimized physical and medical therapy in knee osteoarthritis.Ann Intern Med. 2009 Jan 20;150(2):JC1-15. doi: 10.7326/0003-4819-150-2-200901200-02015. Ann Intern Med. 2009. PMID: 19172720 No abstract available.
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Is arthroscopic surgery a beneficial treatment for knee osteoarthritis?Nat Clin Pract Rheumatol. 2009 Mar;5(3):122-3. doi: 10.1038/ncprheum1020. Nat Clin Pract Rheumatol. 2009. PMID: 19252514
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Arthroscopic surgery did not provide additional benefit to physical and medical therapy for osteoarthritis of the knee.J Bone Joint Surg Am. 2009 May;91(5):1281. doi: 10.2106/JBJS.9105.ebo3. J Bone Joint Surg Am. 2009. PMID: 19411490 No abstract available.
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Arthroscopic surgery provides no additional benefit over physiotherapy and medication for the treatment of knee osteoarthritis.Aust J Physiother. 2009;55(2):137. doi: 10.1016/s0004-9514(09)70045-5. Aust J Physiother. 2009. PMID: 19534013
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