According to a new study published in The New England Journal of Medicine, arthroscopic knee surgery for people suffering
from osteoarthritis doesn’t reduce joint symptoms or improve its function compared with optimal nonsurgical treatment.
Researchers at the University of Western Ontario and the Lawson Health Research Institute in Canada examined the effectiveness of arthroscopic surgery, a widely accepted method for treating osteoarthritis of the knee. It involves small incisions to insert a thin, flexible fiber-optic scope and other small instruments into the knee joint to remove pieces of cartilage and smooth the joint surfaces. Arthroscopy is also used to repair other knee problems.
The research team, composed of orthopaedic surgeons, rheumatologists, and physiotherapists treated 178 London-area patients with moderate to severe osteoarthritis of the knee from 1999 to 2007. The participants were on average 60 years old.
All of the patients were provided with physical therapy as well as medications such as ibuprofen or acetaminophen; 86 of the patients also received arthroscopic surgery. They were then tracked for two years to assess the severity of their osteoarthritis.
The researchers found that both groups of patients experienced similar improvements in joint pain, stiffness, and function.
At the end of two years, the researchers concluded that compared with nonsurgical treatment, arthroscopic surgery of the knee did not improve joint symptoms or function for people suffering from osteoarthritis of the knee.
Acupuncture Relieves Pain and Improves Function in Knee Osteoarthritis
Acupuncture provides pain relief and improves function for people with osteoarthritis of the knee and serves as an effective complement to standard care. The findings of the study–the longest and largest randomized, controlled phase III clinical trial of acupuncture ever conducted–were published in the December 21, 2004, issue of the Annals of Internal Medicine.
The multi-site study team, including rheumatologists and licensed acupuncturists, enrolled 570 patients, aged 50 or older with osteoarthritis of the knee. Participants had significant pain in their knee the month before joining the study, but had never experienced acupuncture, had not had knee surgery in the previous 6 months, and had not used steroid or similar injections. Participants were randomly assigned to receive one of three treatments: acupuncture, sham acupuncture, or participation in a control group that followed the Arthritis Foundation’s self-help course for managing their condition. Patients continued to receive standard medical care from their primary physicians, including anti-inflammatory medications, such as COX-2 selective inhibitors, non-steroidal anti-inflammatory drugs, and opioid pain relievers.
“For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee,” said Stephen E. Straus, M.D., NCCAM Director. “These results also indicate that acupuncture can serve as an effective addition to a standard regimen of care and improve quality of life for knee osteoarthritis sufferers.”
During the course of the study, led by Brian M. Berman, M.D., Director of the Center for Integrative Medicine and Professor of Family Medicine at the University of Maryland School of Medicine, Baltimore, Maryland, 190 patients received true acupuncture and 191 patients received sham acupuncture for 24 treatment sessions over 26 weeks. Sham acupuncture is a procedure designed to prevent patients from being able to detect if needles are actually inserted at treatment points. In the education control group, 189 participants attended six, 2-hour group sessions over 12 weeks based on the Arthritis Foundation’s Arthritis Self-Help Course, a proven, effective model.
Patients’ progress was assessed at 4, 8, 14, and 26 weeks. By week 8, participants receiving acupuncture were showing a significant increase in function and by week 14 a significant decrease in pain, compared with the sham and control groups. These results, shown by declining scores on the WOMAC index, held through week 26. Overall, those who received acupuncture had a 40 percent decrease in pain and a nearly 40 percent improvement in function compared to baseline assessments.
“This trial, which builds upon our previous NCCAM-funded research, establishes that acupuncture is an effective complement to conventional arthritis treatment and can be successfully employed as part of a multidisciplinary approach to treating the symptoms of osteoarthritis,” said Dr. Berman.