Arthroscopic debridement for knee osteoarthritis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 23 JAN 2008
Assessed as up-to-date: 11 NOV 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritis. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD005118. DOI: 10.1002/14651858.CD005118.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 23 JAN 2008
Knee osteoarthritis (OA) is a progressive disease that initially affects the articular cartilage. Observational studies have shown benefits for arthroscopic debridement (AD) on the osteoarthritic knee, but other recent studies have yielded conflicting results that suggest AD may not be effective.
To identify the effectiveness of AD in knee OA on pain and function.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006); MEDLINE (1966 to August, 2006); CINAHL (1982 to 2006); EMBASE (1988 to 2006) and Web of Science (1900 to 2006) and screened the bibliographies, reference lists and cited web sites of papers.
We included randomised controlled trials (RCT) or controlled clinical trials (CCT) assessing effectiveness of AD compared to another surgical procedure, including sham or placebo surgery and other non-surgical interventions, in patients with a diagnosis of primary or secondary OA of the knees, who did not have other joint involvement or conditions requiring long term use of non-steroidal anti-inflammatory drugs (NSAIDs). The main outcomes were pain relief and improved function of the knee.
Data collection and analysis
Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. Results are presented using weighted mean difference (WMD) for continuous data and relative risk (RR) for dichotomous data, and the number needed to treat to benefit (NNTB) or harm (NNTH).
Three RCTs were included with a total of 271 patients. They had different comparison groups and a moderate risk of bias. One study compared AD with lavage and with sham surgery. Compared to lavage the study found no significant difference. Compared to sham surgery placebo, the study found worse outcomes for AD at two weeks (WMD for pain 8.7, 95% CI 1.7 to 15.8, and function 7.7, 95% CI 1.1 to 14.3; NNTH=5) and no significant difference at two years. The second trial, at higher risk of bias, compared AD and arthroscopic washout, and found that AD significantly reduced knee pain compared to washout at five years (RR 5.5, 95% CI 1.7 to 15.5; NNTB=3). The third trial, also at higher risk of bias, compared AD to closed-needle lavage, and found no significant difference.
There is 'gold' level evidence that AD has no benefit for undiscriminated OA (mechanical or inflammatory causes).
Plain language summary
Arthroscopic debridement for osteoarthritis of the knee
This summary of a Cochrane review presents what we know from research about the effect of arthroscopic debridement (AD) for osteoarthritis (OA) of the knee.
The review shows that in people with OA, arthroscopic debridement:
- Probably does not improve pain or ability to function compared to placebo (sham surgery)
- Probably leads to little or no difference in pain or ability to function compared to lavage
- May improve pain compared to washout
- May not lead to any difference in pain or ability to function compared to closed needle joint lavage
We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. Possible side effects may include a small risk of infection and of venous thromboembolism.
What is osteoarthritis and what is arthroscopic debridement?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. OA can occur in different areas of the knee or the whole knee. When the cartilage breaks down, bits of tissue are left around the joint which can add to the inflammation and prevent the joint from working properly.
Arthroscopic debridement (AD) involves using instruments to remove damaged cartilage or bone. Often the doctor will start the procedure by using a tool to spray jets of fluid to wash and suck out all debris around the joint. This is called lavage or washout. Then, the parts of the joint bone that are loose or misshapen are removed.
Best estimate of what happens to people with OA who have arthroscopic debridement compared with washout:
Pain: 66 more people out of 100 reported being pain free after 1 year and 48 more people out of 100 reported being pain free after 2 years. These results are based on low quality evidence.
Best estimate of what happens to people with OA who have arthroscopic debridement compared with placebo:
Pain two weeks after treatment: Pain scores increased by 9 more points on a scale of 0-100.
Physical function two weeks after treatment: The ability to function improved 8 more points on a scale of 0-100 for the placebo group. These results are based on moderate quality evidence.
Physical function 12 months after treatment: The ability to function improved 7 more points on a 0-100 scale for the placebo group, indicating that the AD group experienced significantly more limited function. These results are based on low quality evidence.
The numbers given are our best estimate. When possible, we have also presented a range because there is a 95 percent chance that the true effect of the treatment lies somewhere between that range.
搜尋包括Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006) EDLINE (1966 to August, 2006); CINAHL (1982 to 2006); EMBASE (1988 to 2006 nd Web of Science (1900 to 2006)。同時手動搜尋所選文章之參考文獻。
3個研究包含271例病患於分析中。各研究之比較組不同，且有中度偏差風險。1篇研究關節鏡清除比較沖洗與比較假手術，關節鏡清除比上沖洗並無顯著差異，關節鏡清除比假手術結果在2週更差(疼痛WMD 8.7, 95% CI 1.7 to 15.8, 功能7.7, 95% CI 1.1 to 14.3; NNTH = 5)且在2年時並無顯著差異。第2篇研究，結果有高度偏差風險，關節鏡清除比上關節鏡沖洗，在5年時顯著減少疼痛(RR 5.5, 95% CI 1.7 to 15.5; NNTB = 3)。第3篇研究，結果亦有高度偏差風險，比較關節鏡清除與穿針沖洗，發現並無顯著差異。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
關節鏡清除術治療膝退化性關節炎。此Cochrane review摘要介紹了我們所知道的有關關節鏡清除術(AD)治療膝退化性關節炎(OA)的效果。回顧表明，在退化性關節炎患者，關節鏡清除術：與安慰劑(假手術)相比，可能沒有改善疼痛或功能的能力。與沖洗相比，對於疼痛或功能的能力，可能導致很少或根本沒有的差異。 與穿針沖洗相比，對於疼痛或功能的能力，可能導致很少或根本沒有的差異。我們往往沒有副作用和併發症確切的資訊。尤其是罕見但嚴重的副作用。可能的副作用可能包括一個小的感染和靜脈血栓風險。什麼是退化性關節炎和關節鏡清除術是什麼？退化性關節炎(OA)是關節炎最常見的形式，會影響手，髖部，肩膀和膝蓋。在OA，保護兩端骨頭的軟骨破裂，導致疼痛和腫脹。OA可以發生在膝蓋不同區域或整個膝蓋。當軟骨破裂，組織碎片會留在關節周圍，這能夠增強發炎，讓關節無法正常工作。關節鏡清除術(AD)涉及使用工具來去除損壞的軟骨或骨頭。通常醫生會使用這步驟，通過使用工具來噴射液體沖洗吸出關節周圍所有的碎片。這就是所謂灌洗或沖洗。然後，該部份關節骨會鬆散或骨畸形會被移除。退化性關節炎患者使用關節鏡清除術相比於沒有用沖洗術，最樂觀估計會發生什麼事：疼痛：每100人有66人報告1年後無疼痛，每100人有48人報告2年後無疼痛。這些結果是根據低品質的證據。退化性關節炎患者使用關節鏡清除術相比於安慰劑組，最樂觀估計會發生什麼事：疼痛：治療2周後：：疼痛評分增加了9分(0 – 100分量表)。治療兩個星期後生理功能：功能能力改善8分(安慰劑組0 – 100分量表)。這些結果是根據中等品質的證據。治療12個月後生理功能：功能能力改善7分(安慰劑組0 – 100分量表)，這表明AD組功能改善有限。這些結果是根據低品質的證據。列舉的數字是我們最好的估計。如果可能，我們也提出了一個範圍，因為有95% 的機會，真正的治療效果介於這個範圍之間。