Useless arthroscopy in osteoarthritis of the knee medicine transparent

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

Arthroscopy (joint reflection) cannot relieve knee pain or improve mobility. There are no benefits in knee osteoarthritis.

Stiff, painful joints in old age are a common problem. Cause: Wear of the normally protective cartilage layer in the joint. Excessive or incorrect stress leads to friction and inflammation in the joint, hurts and stiffens. Osteoarthritis most often occurs in the knee and hip joints.

What does arthroscopy do for osteoarthritis?

Arthroscopy (joint reflection) is often recommended for people with osteoarthritis of the knee. Doctors use small cameras to look directly into the joint through small incisions. It usually does not just assess the condition of the affected cartilage and meniscus: Arthroscopy usually involves minor interventions, such as rinsing the joint or smoothing the cartilage surface. The goal: to “clean 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.

But what may sound logical has a catch: arthroscopy is uselessly treated for osteoarthritis. The current review reaches this clear conclusion [1].


The study clearly speaks against the benefits

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

Osteoarthritis in osteoarthritis: ineffective but not too risky

However, side effects were not observed with a particularly high frequency in the arthroscopy groups. The procedure does not seem to be very risky, but the available data are not reliable enough to be completely ruled out.

Austria is valid, Germany is not

In Germany, arthroscopy as a treatment for knee osteoarthritis has not been covered by health insurance since 2016. Reason: insufficient efficiency. In Austria, however, health insurance companies do not seem to mind. In this country, the cost of arthroscopy is always reimbursed – for whatever reason.


Osteoarthritis: what helps?

Severe obesity and poor position put a strain on the knee joints. This may promote the development of osteoarthritis at a younger age. Weight loss can reduce pain and improve the mobility of affected joints. However, rest is not a good idea for osteoarthritis, on the contrary: Appropriate exercise helps keep the joint stable, supplies the cartilage with nutrients and “lubricates” the joint. Good examples are aerobics, walking, yoga, swimming and cycling [2,3]. Pain medications can also provide short-term relief. However, osteoarthritis cannot be cured.

In many cases, surgery is sometimes necessary in which the affected joint is partially or completely replaced by an artificial joint prosthesis.

Disputed drugs for osteoarthritis

The degree of suffering associated with osteoarthritis is usually high and people with disabilities want effective treatment. Providers of various treatments and supplements, whose benefits are questionable, are also aware of this.

For example, we have 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 have any benefits.

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

The effectiveness of some interventions, such as stem cell therapy and treatment with pulsating magnetic fields, which you often have to pay for yourself, has not been studied. The effectiveness of ultrasound therapy has also not been proven.

On the other hand, autohemotherapy and avocado and soybean oil or incense could help.

Find out more

You can find more reliable information on osteoarthritis at www.gesundheitsinformation.de. You can read more about when arthroscopy makes sense and when it doesn’t.
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 renewed search, we found the current overview article. Their results strengthen confidence in our original assessment.
  • 8/22/2014: First publication of the article.

Is it easy to understand? Did he answer your question?

Study in detail

What studies were we looking for?

Anyone who swallows a drug and is convinced of its effect is very likely to feel the effect – even if there may not be any active substance at all. This is called the placebo effect. Surgical interventions can have an even greater placebo effect than drugs – this is known from studies [4].

So to find out if people with osteoarthritis are doing better after arthroscopy, the best way to compare their symptoms is with a group of people who just think they have had arthroscopy. In reality, however, they have only had a so-called mock operation. In sham operations, the patient is anesthetized and a skin incision is made – nothing more. Of course, this only happens in clinical trials and each participant gives their prior consent to participate.

Such studies are the most reliable way to assess the effectiveness of arthroscopy. The review we found summarizes the results of four such studies involving 309 people [1]. Half of these people underwent either arthroscopy to flatten the meniscus or flushing the joint with saline. The other half had no or false arthroscopy. After 3 months to 2 years, participants had approximately the same number of complaints, regardless of whether they were actually treated or not.

So we come to our evaluation

We have great confidence in the result because

  • The reviews and studies summarized in it are of good quality
  • and all studies come to very similar conclusions.

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

Scientific resources

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

[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, & Stason, WB (2000). Do medical devices have enhanced placebo effects? Journal of Clinical Epidemiology, 53 (8), 786-792. (link to study)

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