Orthopaedic Surgeons Perceptions on Arthroscopy for Knee OA
Background Osteoarthritis is one of the most common diseases of the joints in adults and a major contributor to functional impairment and reduced independence. Current treatment strategies include physical, pharmacological, and various surgical therapies. Knee arthroscopy is one such treatment that is frequently performed despite considerable evidence that suggests it provides no relevant therapeutic benefit.
Methods To examine current practice patterns, a survey was conducted among 279 orthopaedic surgeons from 57 countries regarding their use of knee arthroscopy for knee osteoarthritis. Surgeons' preferences were stratified by country of origin, field of specialty, number of years of experience, and status.
Results The vast majority of orthopaedic surgeons surveyed would not perform knee arthroscopy for knee osteoarthritis (73%). Among the remaining 27%, this technique was more often preferred by surgeons practicing in Europe and other parts of the world (29.8%) compared with North America (15.6%) (P=0.02), regardless of seniority or field of subspecialty.
Conclusions Although controversy exists regarding arthroscopic treatment of knee osteoarthritis, it is still preferred by more than one-quarter of orthopaedic surgeons surveyed worldwide; a significantly greater proportion of those surgeons practice outside North America.
Osteoarthritis (OA) is a progressive degenerative disease that manifests as joint pain, loss of function, and deformity. OA is the most common cause of walking-related disability among older adults in the United States, and the prevalence and incidence of OA are increasing rapidly. The direct cost of osteoarthritis is considerable with over $80 billion spent each year in the United States, and almost $50 billion more in indirect costs.
The etiology of knee OA is multifactorial and includes generalized constitutional factors (e.g., aging, sex, obesity, heredity, and reproductive variables), local adverse mechanical factors (e.g., joint trauma, occupational and recreational abuse, alignment, and postmeniscectomy), and geographic factors. Clinically, OA is diagnosed on the basis of a history and physical examination. Radiography is used to confirm clinical suspicion and exclude other conditions. When radiography is used along with physical examination, sensitivity and specificity are 91% and 86%, respectively.
Management of OA of the knee has traditionally focused on treating pain and disability related to this disorder. However, a broader approach that includes prevention and intervention that slows down or limits disease progression in affected joints is now recommended. Initial treatment modalities usually are nonsurgical, and these include exercise, physical therapy, bracing, nonsteroidal antiinflammatory drugs, and intra-articular injections of steroids and viscosupplements. The role of surgical treatment in osteoarthritis of the knee continues to evolve. Usually, if symptoms persist after conservative treatment, surgical interventions should be considered, and these include arthroscopic debridement, cartilage repair surgery, osteotomy with axis correction, and unicompartmental or total knee arthroplasty. Arthroscopic debridement and lavage have been used extensively for the treatment of knee OA for nearly 70 years. The goal of arthroscopy is to reduce synovitis and eliminate mechanical interference with joint motion. However, in recent years there has been increasing controversy regarding the effectiveness of arthroscopy for knee OA.
The aim of the current international questionnaire study was to determine orthopaedic surgeons' perception regarding the use of arthroscopy in the management of OA of the knee. We hypothesized that considering the strong evidence and clinical guidelines against performing arthroscopy for knee OA, orthopaedic surgeons will advise against it.
Abstract and Introduction
Abstract
Background Osteoarthritis is one of the most common diseases of the joints in adults and a major contributor to functional impairment and reduced independence. Current treatment strategies include physical, pharmacological, and various surgical therapies. Knee arthroscopy is one such treatment that is frequently performed despite considerable evidence that suggests it provides no relevant therapeutic benefit.
Methods To examine current practice patterns, a survey was conducted among 279 orthopaedic surgeons from 57 countries regarding their use of knee arthroscopy for knee osteoarthritis. Surgeons' preferences were stratified by country of origin, field of specialty, number of years of experience, and status.
Results The vast majority of orthopaedic surgeons surveyed would not perform knee arthroscopy for knee osteoarthritis (73%). Among the remaining 27%, this technique was more often preferred by surgeons practicing in Europe and other parts of the world (29.8%) compared with North America (15.6%) (P=0.02), regardless of seniority or field of subspecialty.
Conclusions Although controversy exists regarding arthroscopic treatment of knee osteoarthritis, it is still preferred by more than one-quarter of orthopaedic surgeons surveyed worldwide; a significantly greater proportion of those surgeons practice outside North America.
Introduction
Osteoarthritis (OA) is a progressive degenerative disease that manifests as joint pain, loss of function, and deformity. OA is the most common cause of walking-related disability among older adults in the United States, and the prevalence and incidence of OA are increasing rapidly. The direct cost of osteoarthritis is considerable with over $80 billion spent each year in the United States, and almost $50 billion more in indirect costs.
The etiology of knee OA is multifactorial and includes generalized constitutional factors (e.g., aging, sex, obesity, heredity, and reproductive variables), local adverse mechanical factors (e.g., joint trauma, occupational and recreational abuse, alignment, and postmeniscectomy), and geographic factors. Clinically, OA is diagnosed on the basis of a history and physical examination. Radiography is used to confirm clinical suspicion and exclude other conditions. When radiography is used along with physical examination, sensitivity and specificity are 91% and 86%, respectively.
Management of OA of the knee has traditionally focused on treating pain and disability related to this disorder. However, a broader approach that includes prevention and intervention that slows down or limits disease progression in affected joints is now recommended. Initial treatment modalities usually are nonsurgical, and these include exercise, physical therapy, bracing, nonsteroidal antiinflammatory drugs, and intra-articular injections of steroids and viscosupplements. The role of surgical treatment in osteoarthritis of the knee continues to evolve. Usually, if symptoms persist after conservative treatment, surgical interventions should be considered, and these include arthroscopic debridement, cartilage repair surgery, osteotomy with axis correction, and unicompartmental or total knee arthroplasty. Arthroscopic debridement and lavage have been used extensively for the treatment of knee OA for nearly 70 years. The goal of arthroscopy is to reduce synovitis and eliminate mechanical interference with joint motion. However, in recent years there has been increasing controversy regarding the effectiveness of arthroscopy for knee OA.
The aim of the current international questionnaire study was to determine orthopaedic surgeons' perception regarding the use of arthroscopy in the management of OA of the knee. We hypothesized that considering the strong evidence and clinical guidelines against performing arthroscopy for knee OA, orthopaedic surgeons will advise against it.
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