Arthroscopic debridement for knee osteoarthritis

Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C

Summary

Arthroscopic debridement for osteoarthritis of the knee
This summary of a Cochrane review presents what we know from research about the effect of arthroscopic debridement (AD) for osteoarthritis (OA) of the knee.

The review shows that in people with OA, arthroscopic debridement:

• Probably does not improve pain or ability to function compared to placebo (sham surgery)
• Probably leads to little or no difference in pain or ability to function compared to lavage
• May improve pain compared to washout
• May not lead to any difference in pain or ability to function compared to closed needle joint lavage

What is osteoarthritis and what is arthroscopic debridement?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. OA can occur in different areas of the knee or the whole knee. When the cartilage breaks down, bits of tissue are left around the joint which can add to the inflammation and prevent the joint from working properly.

Arthroscopic debridement (AD) involves using instruments to remove damaged cartilage or bone. Often the doctor will start the procedure by using a tool to spray jets of fluid to wash and suck out all debris around the joint. This is called lavage or washout. Then, the parts of the joint bone that are loose or misshapen are removed.

Best estimate of what happens to people with OA who have arthroscopic debridement compared with washout:

Pain: 66 more people out of 100 reported being pain free after 1 year and 48 more people out of 100 reported being pain free after 2 years. These results are based on low quality evidence.

Best estimate of what happens to people with OA who have arthroscopic debridement compared with placebo:

Pain two weeks after treatment: Pain scores increased by 9 more points on a scale of 0-100.

Physical function two weeks after treatment: The ability to function improved 8 more points on a scale of 0-100 for the placebo group. These results are based on moderate quality evidence.

Physical function 12 months after treatment: The ability to function improved 7 more points on a 0-100 scale for the placebo group, indicating that the AD group experienced significantly more limited function. These results are based on low quality evidence.

The numbers given are our best estimate. When possible, we have also presented a range because there is a 95 percent chance that the true effect of the treatment lies somewhere between that range.