In a recent paper published in BMJ, the authors have condemned the arthroscipic surgery in degenerative knee reporting more harm than good even in patients around 40 years of age.
I have been doing this surgery for the last more than 20 years as a first choice in patients below fifties, and selectively in elderly patients who, due to economic/ social/ personal reasons do not want joint replacement. After this paper I compiled my data of last 10 years. Out of 40 knees, only 3 have converted into TKR. During surgery I use meniscal/ synovial debridement, osteophytectomy, microfractures etc depending upon pathologies. In some patients I also combined viscosupplementation at 4- 6 weeks post surgery.
Arthroscopic surgery in Osteoarthrits (OA) knee may be useful in mild to moderate OA and is usually not effective is advanced stages. We do it mainly for 2 indications:
1. Recurrent effusion
2. Mechanical symptoms (due to meniscal tears, loose bodies etc)
In our experience microfracture does not work as well in OA knee as in isolated chondral defects due to non-OA pathology.
Thanks Dr Vaishya. If in a 40 years old patient undergoing arthroscopic surgery for degenerative knee, there is grade IV chondral damage of the articular surface, do you leave them alone?
A 40-year-old normally should not have such a lesion due to OA. It is usually due to a traumatic cause and in such a scenario, I would prefer to do MF
Dear colleagues, George Bentley,pioneer in chondrocyte culture and transplantation of articular cartilage,had said in 1991,if I remember well, in an instructional course.,that if we had the surgical time a repetition of arthroscopic knee washouts would possibly delay the quick development of the articular degeneration. For some other reasons (increased waiting lists, exenditure, insurance disputes,,fear of potential post surgical complications,development of MRI etc.) washouts fell out of fashion. Operations became more complicated ( microfractures,arthroscopic debridements etc) and now are slowly are condemned. To function correctly we need to understand the way of the articular cartilage's nutrition and how we can preserve it. Till this time we will doubt our own actions.
I share the indications pointed out by Dr. Vaishya. Arthroscopic wash out gives little or no benefit for advanced OA-patients.
Arthroscopy is of no value in treatment f OA of the knee, patient only get worse. Of course with surgery placebo effect is strong. Treatment for young age group includes particularly various types of osteotomies, nothing or replacement in the most severe cases.
I agree, that one of the worst indication of arthroscopic surgery is Osteoarthritis. One must resist in doing it until, it is absolutely mandatory!!!
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