The rate of knee arthroscopies performed for osteoarthritis has decreased in the United States after a clinical trial in 2002 found no difference between arthroscopy and a placebo procedure for patients with osteoarthritis, according to a study published in the Orthopedic Journal of Sports Medicine.
In 2002, J. Bruce Moseley, MD, from the Houston Veterans Affairs Medical Center, and colleagues conducted a randomized controlled trial that found that the outcomes after arthroscopy for knee osteoarthritis were no better than the outcomes after a placebo procedure. Therefore, Morgan H. Jones, MD, MPH, from the Cleveland Clinic in Ohio, and colleagues hypothesized that the rate of knee arthroscopy would decrease after the publication of this trial, and sought to assess the impact of the trial on clinical practice in the United States.
The investigators used the State Ambulatory Surgery Database to analyze cases from 1998 to 2006, which were classified as meniscus tear, osteoarthritis, or osteoarthritis with a meniscus tear. They evaluated changes in age, surgery rates, and case classification before and after the trial in 2002.
The results showed that the rate of knee arthroscopies per year increased from 155,057 in 1998 to 172,317 in 2006, and the mean patient age increased from 47.6 years to 49.2 years.
The researchers noted that they identified an increase in arthroscopic procedures after the publication of the article, but a significant decrease occurred in the frequency of knee arthroscopies performed for osteoarthritis.
Arthroscopies for meniscus tears increased from 69.1% to 70.8%, which represents about 15,500 additional cases per year. Arthroscopies for osteoarthritis decreased from 10.6% to 7.2%, representing about 4,000 fewer cases per year, and arthroscopies for osteoarthritis with a meniscus tear increased from 20.3% to 22.0%, representing about 6,400 additional cases per year.
“These findings support the notion that practicing orthopedic surgeons do modify their approach to treatment in response to well-publicized, high-quality clinical outcomes research,” the authors noted. “It is of critical importance that orthopedic surgeons continue to perform clinical research to convey important treatment decisions and disseminate their results to ensure evidence-based medicine.”
- Amin NH, Hussain W, Ryan K, et al. Changes within clinical practice after a randomized controlled trial of knee arthroscopy for osteoarthritis. Orthop J Sports Med. 2017. doi:10.1177/2325967117698439
- Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347:81-88. doi:10.1056/NEJMoa13259