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Surgery not needed for Osteoarthritis

A new study shows these types of procedures may not be any more dynamic than a placebo procedure. Arthroscopy is the most common type of orthopedic surgery, and the knee is the most common joint on which it is performed. The procedure is frequently used to relieve persistent pain caused by osteoarthritis of the knee. However, while half the patients say the surgery relieves their pain whereas researchers say there is no physiological basis for the relief.// They say there is no evidence to show arthroscopy cures osteoarthritis.

In this study, researchers from the Department of Veterans Affairs College of Medicine evaluated the efficacy of arthroscopy for osteoarthritis of the knee. They randomly divided 150 patients with osteoarthritis of the knee into one of three groups. The first group received bridement, a procedure in which worn, torn or loose cartilage is cut away and removed. The second group underwent arthroscopic lavage, which involves flushing out bad cartilage. The final group underwent a placebo procedure, in which the doctor simulated arthroscopic surgery. Small incisions were made for effect, but no cartilage was removed. The surgeries were performed by the same orthopedic surgeon.

To determine the result of the surgeries, patients were assessed regularly for 25 months. Findings show patients in all three groups reported moderate improvement in pain and ability to function. Authors of the study write, "At no point did either of the intervention groups report less pain or better function than the placebo group."

Researchers say the lack of difference in the outcome of the procedures indicates improvement is not necessarily due to any intrinsic effects. Instead, they say it may be the result of the natural history of the condition.

Thus the study concludes that, if the efficacy of arthroscopic lavage or d?bridement in patients with osteoarthritis of the knee is no greater than that of placebo surgery, the billi ons of dollars spent on such procedures annually might be put to better use.


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