Arthritic Knees Remain Painful After Arthroscopic Surgery

Posted 1/25/08

Trimming damaged tissue through arthroscopic surgery does not relieve pain and swelling in arthritic knees any better than simply flushing loose debris from the joint, according to a new review of evidence. However, the technique, known as arthroscopic debridement (AD), might still improve comfort and mobility in some subsets of patients with osteoarthritis, the review authors say.

Osteoarthritis causes cartilage — which cushions the ends of bones — to break down. Loose bits of tissue can then cause pain, swelling and poor joint function.

Arthroscopic surgery for knee osteoarthritis can include a number of different procedures. These range from lavage, which is flushing and suctioning debris from the joint, to methods like debridement for trimming damaged cartilage and bone spurs.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Possible side effects of arthroscopic surgery include a small risk of infection and blood clots. Moreover, the procedure does not stop the progression of osteoarthritis. Symptoms of the disease are likely to return over time and surgical realignment or replacement of the joint could ultimately be necessary.

“The only osteoarthritis patients I typically consider for arthroscopic surgery are those with mild to moderate disease and mechanical symptoms in the knee,” said Scott Zashin, MD, a rheumatologist at the University of Texas Southwestern Medical Center. Such symptoms occur when fragments of cartilage interfere with the joint, causing a painful popping sensation or even locking or buckling of the knee.

“Future research on this topic should analyze larger numbers of participants with various types of soft-tissue damage and levels of arthritis severity,” the review authors say.

Unfortunately, medical treatments today are limited to relieving symptoms with drugs or surgery, according to Zashin. “I’m optimistic that more research will be done in terms of preventing further damage and loss of cartilage for those who have osteoarthritis.”

In the meantime, he added, obesity is a known risk factor for osteoarthritis in weight-bearing joints. “For patients who are overweight, losing weight seems to help them feel better and slow down progression of the disease.”

This article was adapted from a press release issued by the Center for the Advancement of Health.

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