A controlled trial of arthroscopic surgery for osteoarthritis of the knee.
Level 2 - randomized trial
Individual randomized trial with sham-surgery control
PubMed 12110735 · doi:10.1056/NEJMoa013259
What was done
A randomized, double-blind, placebo-controlled trial evaluated the efficacy of arthroscopic surgery in 180 patients with knee osteoarthritis. Participants were assigned to arthroscopic débridement, arthroscopic lavage, or placebo surgery (skin incisions and simulated débridement without arthroscope insertion). Patients and outcome assessors were blinded. Outcomes were tracked over 24 months using five self-reported pain and function scales and one objective walking/stair-climbing test. A total of 165 patients completed the study.
What was found
Neither surgical intervention group outperformed placebo at any time point. On the Knee-Specific Pain Scale (0 to 100, higher is worse pain), 1-year mean (±SD) scores were 48.9 ± 21.9 for placebo, 54.8 ± 19.8 for lavage (p = 0.14 vs. placebo), and 51.7 ± 22.4 for débridement (p = 0.51 vs. placebo). At 2 years, scores were 51.6 ± 23.7 for placebo, 53.7 ± 23.7 for lavage (p = 0.64), and 51.4 ± 23.2 for débridement (p = 0.96). The 95% confidence intervals for group differences excluded clinically meaningful benefits.
Why it matters
This landmark trial demonstrated that common arthroscopic procedures for knee osteoarthritis yield outcomes equivalent to a sham procedure, challenging routine surgical intervention for this condition.
Limits
The abstract does not describe participant demographics, baseline disease severity, or specific exclusion criteria. Fifteen of 180 participants (8.3%) did not complete the 24-month follow-up.
Cited by
- context A New England Journal of Medicine study comparing knee surgery to a sham incision procedure found no difference in clinical outcomes between the two groups.