Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Arthroscopic knee surgery ineffective

The New England Journal of Medicine has published the results of a study that aimed to assess the efficacy of arthroscopic surgery in patients with osteoarthritis of the knee. The general media have reported this study (BBC).

The study recruited 178 patients with moderate to severe osteoarthritis of the knee. All patients received optimized physical and medical therapy with 92 patients randomly assigned to undergo surgery to involve lavage and debridement. 86 patients actually underwent the surgical procedure.

The primary outcome of the study was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score that assesses symptoms, pain, stiffness and functioning. A secondary outcome assessed quality of life.

At the end of the two-year study there was no statistical difference in either the primary or secondary outcome. Additionally, there were no differences at any of the interim analyses. The authors conclude that, "arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy".

Current NICE Guidance (PDF) does allow this procedure on the NHS however the document states that, "treatment options depend on the severity of the osteoarthritis" and that, "patient selection is important".

Action: Clinicians should ensure that this procedure is only carried out on patients who are likely to gain most benefit. All patients should receive optimized physical and medical therapy.

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