Arthroscopy of the knee joint without improvement

Surgical intervention in knee joint arthrosis no more effective than physiotherapy

05/13/2014

In a knee joint osteoarthritis can be achieved by surgery, no greater success than by a non-drug treatment such as a targeted physiotherapy. Researchers at the Institute for Quality and Efficiency in Health Care (IQWiG) came to this conclusion.

17 percent of all men and 27 percent of women are affected by gonarthrosis
When the knees become stiff and every step causes massive pain in some cases, there is often a so-called "older" person „Knee osteoarthritis“ (Gonarthrosis). It is a premature wear of the cartilaginous articular surfaces of the knee joint, which is one of the most common signs of wear in the joints. In this country, the gonarthrosis affects about 17 percent of all men and 27 percent of all women in the course of their life, in which by deposits or increased stress (activity in the knees, obesity, malpositions, arthritis, etc.), the cartilage layer gradually goes back and later even the articular bones can be attacked. If osteoarthritis of the knee is present, this often manifests itself first as a result of severe pain at the beginning of the movement (onset pain), which only slowly subside, but then reappear after prolonged exercise. In addition to pain after prolonged sitting as well as crunching and crackling noises when moving the knee, in the further course it comes to pain in the resting state.

In arthroscopy, the joint is cleaned and rinsed, and the cartilage is smoothed
In order to maintain joint mobility and achieve freedom from pain, arthroscopic surgery (arthroscopy) is often performed in advanced knee osteoarthritis in which the joint is cleaned and rinsed and, if necessary, degenerated or smoothed pathologically altered meniscal or cartilage portions (debridement). The advantage of this minimally invasive procedure is usually seen in the fact that comparatively little tissue is injured and only a few tiny scars remain. But apparently, this surgical technique has its limits - because as scientists of the Institute for Quality and Efficiency in Health Care (IQWiG) have now found, this does not relieve the symptoms better than non-drug treatments such as physiotherapy. Accordingly, this intervention could basically be dispensed with from the outset and immediately set to gentler therapeutic procedures.

No indication or proof of benefit of therapeutic arthroscopy
How useful is therapeutic arthroscopy actually? Researchers at the Institute for Quality and Efficiency in Healthcare responded to this question by evaluating eleven studies comparing them with several other measures such as non-treatment, sham treatment, drug (eg cortisone injection) and non-drug treatment. The researchers examined how the various measures impacted patients' quality of life and activity, as well as the extent to which pain was alleviated or side effects occurred. This revealed a clear result: In most cases, arthroscopy had no more positive effect than a sham operation - instead, the placebo effect in the sham arthroscopy but strikingly strong, the scientists. It was also shown that other forms of therapy, such as targeted physiotherapy, could alleviate the symptoms as well as surgery. „The benefit of therapeutic arthroscopy with lavage and possibly debridement for the treatment of osteoarthritis of the knee joint (gonarthrosis) has not been established. No patient-relevant endpoint showed any indication or evidence of benefit from therapeutic arthroscopy in comparison to non-active comparative interventions, such as sham surgery“, that's the overall result of the IQWiG. (No)