August 2002 AAOS Report

AAOS Executive VP responds to arthroscopic trial study

The New England Journal of Medicine on July 11, 2002 published a report on a randomized, placebo-controlled trial involving use of arthroscopy in treatment of patients with osteoarthritis of the knee. This article was widely reported in the lay press and has generated some controversy within the orthopaedic profession. William W. Tipton, Jr., MD, AAOS executive vice president, has issued the following response to publication of the study:

"We applaud the authors and the patients who participated in the placebo-controlled investigation on the role of arthroscopy in osteoarthritis of the knee. Evidence-based medicine should be a guiding light in today's health care delivery system, and this study confirms the conventional orthopaedic wisdom on the limited value of arthroscopic cleansing of arthritic knees.

"The strengths of the study include the large size of the patient groups, an excellent control group and the long-term patient assessment. The weaknesses include a potential selection bias caused by the number of patients who decided not to participate and the nonspecific indications for arthroscopy. Additionally, data were not stratified for body weight, malalignment and mechanical symptoms. Arthroscopic surgery may relieve mechanical symptoms (buckling, locking, etc.) thus delaying the need for more aggressive surgery such as total knee replacement.

"The study seems to meet specific ethical criteria such as an informed patient, and the use (or nonuse) of a procedure (placebo) which had little potential for harm to the patient. We recommend attempts to reproduce the findings in subsequent studies in other practice settings with selection for pre-existing malalignment, mechanical symptoms and body weight. The organization also agrees with the authors that an expert panel be convened to review the findings of this study and make recommendations as to the selective use of arthroscopy in the treatment of osteoarthritis of the knee."

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