Comparison of Arthroscopic and Conservative Treatments for Knee Osteoarthritis: A 5-Year Retrospective Comparative Study

Su, Xiangzheng; Li, Chunbao; Liao, Weixiong; Liu, Jianheng; Zhang, Hao; Li, Ji; Li, Zhongli

doi:10.1016/j.arthro.2017.09.023

Cited by 25 publications

(21 citation statements)

References 28 publications

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“…Resection of the synovium may theoretically have beneficial effects. From a clinical standpoint, case series of arthroscopic debridement and synovectomy in the moderate to severe stages of KOA have shown some benefits [21, 22]. However, these were impermanent owing to the relentless progressive nature history of the KOA [23].…”

Section: Discussionmentioning

confidence: 99%

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Liu

Chen

et al. 2019

J Orthop Surg Res

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Background During primary total knee arthroplasty (TKA), synovectomy as a part of the procedure has been recommended to relieve pain and inflammation of the synovium, but there is a controversy about it due to increased bleeding. In this meta-analysis, the aim is to answer whether synovectomy should be performed routinely during TKA for symptomatic knee osteoarthritis (KOA). Methods Relevant randomized controlled trials (RCTs) on synovectomy were retrieved through database searches of PubMed, Embase, Web of Science, and Cochrane Library up to February 2019. Studies that compared postoperative pain, clinical Knee Society Score (KSS), functional KSS, range of motion (ROM), drainage, pre- and postoperative hemoglobin difference, transfusion rate, operative time, and/or complications were included in the meta-analysis. Review Manager 5.3.0 was used for meta-analysis. Results We included 5 RCTs with 542 knees. Pooled results indicated that the synovectomy group was associated with more blood loss via drainage (WMD = − 99.41, 95% CI − 153.75 to − 45.08, P = 0.0003) and pre- and postoperative hemoglobin difference (WMD = − 0.93, 95% CI − 1.33 to − 0.5, P < 0.00001), compared with the non-synovectomy group. No statistically significant differences were demonstrated between both groups in postoperative pain, clinical KSS, functional KSS, ROM, transfusion rate, or complications ( P > 0.05). Conclusions The current evidence demonstrates that performing synovectomy in primary TKA for symptomatic KOA does not have any clinical benefit. It increases postsurgical blood loss. Surgeons routinely undertaking synovectomy should deliberate whether this is clinically indicated and consider limiting resection, if possible.

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Section: Discussionmentioning

confidence: 99%

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Liu

Chen

et al. 2019

J Orthop Surg Res

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“…Arthroscopy still plays a role in our armamentarium of treatment options for those in whom conservative care fails, who have a history of trauma, and who have lower-grade Kellgren-Lawrence radiographic changes. Indeed, the Level III study by Su et al 1 shows improved Western Ontario and McMaster Universities Osteoarthritis Index scores up to 2 years for patients with even up to grade 3 and 4 changes; these patients were much more likely, however, to require total joint replacement during the 5 years of the study.…”

Section: See Related Article On Page 652mentioning

confidence: 98%

“…Selection bias is more prevalent in lowerlevel studies and may confound the study conclusions. For example, in the Level III study by Su et al, 1 all patients were recommended to undergo arthroscopic surgery and only those who refused were included in the nonsurgical group. This selection process inserts considerable bias because the patients were self-selected on their preference for treatment.…”

Section: See Related Article On Page 652mentioning

confidence: 99%

Editorial Commentary: Are We Running Out of Treatments for Osteoarthritis of the Knee?

McIntyre

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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A considerable body of literature with high-level evidence has been published in the past 15 years calling into question the value of arthroscopic surgery in treating osteoarthritis of the knee (OAK). This, plus recent guidelines advising against the use of conservative treatments such as hyaluronic viscosupplementation, threatens to limit patient access to treatment for a chronic disease state with no known cure. The disease burden of OAK is considerable and represents one of the largest health care dollar expenditures in the United States and the world. Orthopaedic surgeons are the primary specialty dealing with OAK and manage this disease from inception to the final endpoint of total joint arthroplasty. As the population ages and the incidence of OAK increases, we must find ways to improve our ability to show efficacy in our treatments and also promote innovative modalities and applications to ameliorate the disability and dysfunction associated with OAK. Arthroscopy is recognized as a global leader in the presentation of evidence and debate surrounding all treatments for OAK and plays an important role in improving knowledge and treatment efficacy.

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“…15 While surgical treatment (eg, total knee arthroplasty) may significantly decrease pain symptoms and improve range of motion for patients with KOA, it is recommended only for advanced KOA or when conservative treatment is ineffective considering benefit-risk balances. 16,17 Early stage KOA, as is commonly seen in the working population, currently has both a lack of evidence and a lack of options for effective pain-management. 18 Furthermore, with the majority of publications focusing on only single-joint OA, data regarding patients with KOA with multiple-site joint problems are limited.…”

Section: Introductionmentioning

confidence: 99%

<p>Longitudinal Assessment of Pain Management Among the Employed Japanese Population with Knee Osteoarthritis</p>

Ueda¹,

Takura

Fujikoshi³

et al. 2020

CIA

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Purpose: To assess comorbidity burden and pain-management patterns among workingaged patients with knee osteoarthritis only (KOA/O) and patients with knee osteoarthritis plus osteoarthritis at another site (KOA/+) in Japan. Patients and Methods: Retrospective claims data analysis was conducted using the Japan Medical Data Center database. Working-aged adults (aged 40 to 71 years) with 5 years of follow-up and diagnosed with knee osteoarthritis (KOA) between January 1, 2011, and December 31, 2012, were evaluated. The first claim with a KOA diagnosis defined the index date. Patients were divided into two mutually exclusive cohorts: KOA/O and KOA/+. Longitudinal pain-management patterns during each year of follow-up were analyzed. Results: A total of 2542 patients met study criteria: 1575 KOA/O and 967 KOA/+. Mean age and number of comorbidities were higher among the KOA/+ versus KOA/O cohort. Pharmaceutical treatment was received by 91.5% of patients in the KOA/+ compared with 85.1% of patients in the KOA/O cohort during the first year of follow-up. The most common pharmacological treatment received during the first year of follow-up was either topical or oral nonsteroidal anti-inflammatory drugs for both cohorts. During each year of follow-up, the KOA/+ cohort had greater proportion of patients with at least one health-care encounter (ie, hospital admissions, outpatient and pharmacy visits) and higher direct medical costs compared with the KOA/O cohort. Conclusion: This study demonstrates that a greater proportion of the working population with KOA/+ received pain-related treatment compared with patients with KOA/O. Further studies are necessary to evaluate appropriate pain management for both KOA only and KOA with other sites.

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Comparison of Arthroscopic and Conservative Treatments for Knee Osteoarthritis: A 5-Year Retrospective Comparative Study

Abstract: Level III, retrospective comparative study.

Cited by 25 publications

References 28 publications

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

Editorial Commentary: Are We Running Out of Treatments for Osteoarthritis of the Knee?

<p>Longitudinal Assessment of Pain Management Among the Employed Japanese Population with Knee Osteoarthritis</p>

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