The Role of Arthroscopy in Treating Knee OsteoarthritisDebridement or the removal of damaged tissue is an operation commonly used for torn meniscus in the knee. Would it work for people with joint damage from osteoarthritis (OA)? Surgeons from Brown Medical School in Rhode Island studied 122 patients with knee OA to find out.
All patients were treated first with antiinflammatory therapy. They didn't respond well so debridement by arthroscopy was done next. In this operation, the surgeon removed any damaged or loose flaps of cartilage. The edges were smoothed. Any loose pieces were also taken out. The joint was flushed with saline solution to clean it out.
Pain was measured before and after the operation. X-rays were used to assess the joint space width and knee alignment. Success was defined by pain relief. Overall 65 percent of the patients had good pain relief and considered the operation successful. Fifteen percent (15%) of the failures went on to have a total knee replacement.
The authors report most patients had pain relief in the first six months after debridement. Some continued to improve for up to two and a half years after the arthroscopy. They found that patients with good knee alignment before surgery had very little pain after surgery. Anyone with knock-knees (a condition called genu valgus) or narrow joint space had a poor result.
All in all, they found that the severity of the cartilage damage was the best way to predict the final result. The more severe the lesions, the worse the postoperative results. Patients with cartilage damage throughout the entire knee joint had the most pain and were more likely to have a failed arthroscopy.
The authors conclude arthroscopy to debride the joint is a good treatment option for patients with mild OA. Success depends on the severity of cartilage damage, which isn't always known until the time of the operation. Patients must be advised ahead of time that results of debridement can't always be predicted ahead of time.
Roy K. Aaron, MD, et al. Arthroscopic Debridement for Osteoarthritis of the Knee. In The Journal of Bone & Joint Surgery. May 2006. Vol. 88-A. No. 5. Pp. 936-943.
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