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Useless arthroscopy in knee osteoarthritis | transparent medicine

Unfortunately, there are few effective treatments for osteoarthritis. Arthroscopy is not one of them.

Arthroscopy (joint reflection) cannot relieve knee pain or improve mobility. It is not beneficial in knee osteoarthritis.

Stiff, aching joints in old age are a widespread problem. The cause: wear of the normally protective layer of cartilage in the joint. Excessive or incorrect stress leads to friction and inflammation in the joint, hurts and stiffens. Osteoarthritis is most common in the knee and hip joints.

What does arthroscopy do for osteoarthritis?

People with osteoarthritis of the knee joint are often advised to undergo arthroscopy (joint reflexion). Doctors use tiny cameras to look directly into the joint through small incisions. They usually don’t just assess the condition of the affected cartilage and meniscus: minor surgeries such as rinsing the joint or smoothing the surface of the cartilage are usually done during arthroscopy. The goal: to “tidy up” the knee joint, ie to remove loose cartilage particles and tissue fibers and thus reduce friction in the joint. This should relieve the pain.

What may seem logical, however, has a problem: arthroscopy is of no use to anyone being treated for osteoarthritis. A current review comes to this unambiguous conclusion [1].


The studies speak clearly against an advantage

One research team summarized the most significant of all previously published studies on arthroscopy in osteoarthritis of the knee. In these studies, people treated for arthroscopy did not experience significantly less pain or reduced mobility than people who received only dummy treatment or no treatment. This was examined 3 months after the operation. There seemed to be no difference in the quality of life either.

Arthroscopy for osteoarthritis: not very effective, but not very risky

However, adverse events were not observed with a particularly high frequency in the arthroscopy groups. The procedure does not appear to be very risky, but the available data are not reliable enough to completely rule it out.

Austria pays, Germany does not

In Germany, arthroscopy as a treatment for osteoarthritis of the knee has not been paid for by health insurance since 2016. The reason: lack of efficacy. In Austria, however, this doesn’t seem to bother health insurance companies. In this country, the costs for an arthroscopy are always covered, regardless of the reason.


Osteoarthritis: what helps?

Severe obesity and wrong postures put a strain on the knee joints. This can promote the development of osteoarthritis at a young age. Losing weight can reduce pain and improve mobility in affected joints. However, rest is not a good idea with osteoarthritis, on the contrary: proper exercise helps to keep the joint stable, provide nutrients to the cartilage and “lubricate” the joint. Good examples are aerobics, walking, yoga, swimming, and cycling [2,3]. Pain relievers can also provide short-term relief. However, osteoarthritis cannot be cured.

In many cases, surgery is required at some point, in which the affected joint is partially or completely replaced with an artificial joint replacement.

Questionable remedies for osteoarthritis

The level of suffering associated with osteoarthritis is usually high, and those affected desire effective treatment for it. This is also known to the providers of various treatments and dietary supplements, the benefits of which are questionable.

For example, we have already found in other articles that dietary supplements with chondroitin and ointments with DMSO are probably ineffective in osteoarthritis. Likewise, nuclear magnetic resonance therapy does not appear to bring any benefits.

The benefits of hyaluronic acid preparations, pine bark extract, devil’s claw, cat’s claw, turmeric, or rosehip powder have not been proven because too little research has been done.

Neither has the effectiveness of some interventions, such as stem cell therapy and pulsed magnetic field treatment, been studied, which you often have to pay for yourself. The effectiveness of ultrasound therapy has also not been proven.

On the other hand, autohemotherapy and avocado and soy oil or frankincense could help.

Find out more

More reliable information on osteoarthritis can be found at www.gesundheitsinformation.de. You can read more about when an arthroscopy makes sense and when not here.
The German Harding Center for Risk Competence also provides a clear overview of the benefits of arthroscopy in osteoarthritis.

History:

  • June 23, 2022: During a new search, we found a current overview article. Their findings reinforce confidence in our original assessment.
  • 22/08/2014: First publication of the article.

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Studies in detail

What studies were we looking for?

Anyone who ingests a drug and is convinced of its effect will most likely feel the effect, although there may not be any active ingredients. It’s called the placebo effect. Surgeries can have an even greater placebo effect than drugs – this is known from studies [4].

So, to investigate whether people with osteoarthritis are better off after arthroscopy, the best way to compare their symptoms is from a group of people who think they have undergone arthroscopy. In reality, however, they only have a so-called sham operation behind them. In sham operations, the patient undergoes anesthesia and a skin incision is made, nothing more. Of course, this only happens in the context of clinical trials and all people involved give their prior consent to participate.

Such studies are the most reliable way to evaluate the effectiveness of arthroscopy. The review we found summarized the results of four of these studies involving 309 people [1]. Half of these people had arthroscopy to flatten the meniscus or wash the joint with saline. The other half did not have an arthroscopy or a sham. After 3 months or 2 years, the participants had roughly the same number of complaints, regardless of whether they were actually dealt with or not.

We then come to our evaluation

We have great confidence in the result because

  • Both the review and the studies summarized in it are of high quality
  • and all studies come to very similar conclusions.

We believe that future studies are unlikely to come to a very different conclusion.

Scientific sources

[1] O’Connor, D., et al. (2022). “Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears).” Cochrane Database Syst Rev 3 (3): Cd014328. (Link zur Übersichtarbeit)

[2] IQWiG (2021)
Retrieved June 21, 2022, from www.gesundheitsinformation.de

[3] IQWiG (2021)
Retrieved June 21, 2022, from www.gesundheitsinformation.de

[4] Kaptchuk, TJ, Goldman, P., Stone, DA and Stason, WB (2000). Do medical devices have enhanced placebo effects? Journal of Clinical Epidemiology, 53 (8), 786-792. (Link zur Studi)

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