A RANDOMIZED, CONTROLLED TRIAL OF ARTHROSCOPIC SURGERY VERSUS CLOSED-NEEDLE JOINT LAVAGE FOR PATIENTS WITH OSTEOARTHRITIS OF THE KNEE

Objective. To compare arthroscopic surgery and closed-needle joint lavage for patients with non-end-stage osteoarthritis (OA) of the knee under controlled, experimental conditions. Methods. Thirty-two subjects who met specific clinical, radiologic, medical, and rehabilitation criteria were randomized to receive arthroscopic surgery (n = 18) or joint lavage (n = 14). Outcome measures evaluated at baseline and at 3 and 12 months of followup included 3 standard clinical parameters, self-reported pain and functional status (by the Arthritis Impact Measurement Scales), 50-foot walk time, 2 global scales, and direct and indirect medical costs. Results. At 3 months of followup, there were no significant between-group differences in pain, self-reported and observed functional status, and patient and ''blinded'' physician global assessments. The arthroscopic procedure cost $3,840 more than did closed needle joint lavage. After 1 year, there were no between-group differences in medication costs, utilization of medical services, or indirect costs related to employment or use of household help. After 1 year, 44% of subjects who underwent arthroscopy reported improvement and 58% of subjects who underwent joint lavage improved. Patients with tears of the anterior two-thirds of the medial meniscus or any lateral meniscus tear had a higher probability of improvement (by ''blinded'' physician assessment) after arthroscopic surgery (0.63) than did patients with other intraarticular pathology (0.20). Conclusion. The search for and removal of soft tissue abnormalities via arthroscopic surgery does not appear justified for all patients with non-end-stage OA of the knee who fail to respond to conservative therapy, but it may be beneficial for certain subgroups.