Recently there has been discussion of the role of knee arthroscopy in the presence of degenerative osteoarthritis. This has led to some confusion among patients and doctors as to when such surgery is suitable, and when it should be avoided.
The Australian Knee Society through the Australian Orthopaedic Association has published a document dealing with some of these issues. Some relevant findings are as follows:
Arthroscopic debridement, and/ or lavage, has been shown to have no beneficial effect on the natural history of osteoarthritis, nor is it indicated as a primary treatment in the management of osteoarthritis. However, this does not preclude the judicious use of arthroscopic surgery, when indicated, to manage symptomatic coexisting pathology, in the presence of osteoarthritis or degeneration.
When is knee arthroscopy appropriate?
There are certain clinical scenarios in which arthroscopic surgery, in the presence of osteoarthritis, may be appropriate – albeit after considered discussion with the patient. These include, but are not necessarily limited to, the following:
- known or suspected septic arthritis
- Symptomatic meniscal tears after an appropriate trial of non-operative treatment
- Symptomatic loose bodies
- Locked or locking knees
- Meniscal tears that require repair
- Inflammatory arthropathy requiring synovectomy
- Synovial pathology requiring biopsy or resection
- Unstable chondral pathology causing mechanical symptoms
- As an adjunct to, and in combination with, other surgical procedures as appropriate for osteoarthritis: for example high tibial osteotomy and patellofemoral realignment
- Diagnostic arthroscopy when the diagnosis is unclear on MRI or MRI is not possible, and the symptoms are not of osteoarthritis
When to Proceed?
The paper ends by stating that decision to proceed with arthroscopic surgery in the presence of osteoarthritis or degeneration should be made by the treating orthopaedic surgeon:
- After careful review of the clinical scenario: particularly the assessment of the relative contributions of the osteoarthritis, and the arthroscopically treatable pathology, to the patient’s symptoms
- With knowledge of the relevant evidence base, as listed in this document
- After an appropriate trial of non-operative treatment
- After thoughtful discussion with the patient about the relative merits of the procedure versus ongoing non-operative treatment