jsmc-10153

PRIMARY OSTEOARTHRITIS OF THE KNEE: COMPARATIVE STUDY BETWEEN ARTHROSCOPIC DEBRIDEMENT AND SUPERVISED MEDICAL TREATMENT FOR THE STAGE (II AND III) OF THE DISEASE

Areewan Mohammed Salih Saeed a and Nabaz Muhammed Ali b

a Department of Surgery, College of Medicine, University of Sulaimani.

b Department of Surgery, Kalar Hospital, Ministory of Health, Sulaimani, Iraq.

Submitted: 10/10/2017; Accepted: 17/4/2018; Published 1/8/2018

DOI Link: https://doi.org/10.17656/jsmc.10153

ABSTRACT

Background

Osteoarthritis is a chronic disorder of synovial joints with progressive softening and disintegration of articular cartilage accompanied by osteophytes, cyst formation, subchondral sclerosis, synovitis and capsular fibrosis, it can be classified into primary and secondary types. Pain is the usual presenting symptom; modalities of treatment includes: physiotherapy, pharmacotherapy and surgery including arthroscopic debridement, osteotomy or arthroplasty.

Objectives

To assess the effect of arthroscopic debridement in stage II & III primary osteoarthritis of the knee joint and to compare that with the supervised medical therapy.

Patients and Methods

This prospective study was carried out between December 2011 and January 2015, 106 patients with 106 primary knee joint osteoarthritis were included. Age range between 30-60 years, mean (50±7.592); male 43 (40.56%), female 63 (59.43%); male to female ratio was (1:1.45); body mass index (25.50-34.00) mean (29.6375), the right side affected in (48.2%) and left side in (51.8%). The cases were divided into two groups; operative and non-operative group randomly, arthroscopic debridement with lavage in fifty-six patients and supervised medical treatment in fifty patients. Modified WOMAC score were used to evaluate both groups in pre-treatment, one week, one month, 3 months, 6 months and one year after treatment.

Results

In the comparison between the two groups, statistically significant differences were observed at the period of 6 months of treatment while no significant difference observed at the end of one year. Patients assigned to arthroscopic surgery have more improvement in the modified WOMAC score than those assigned to medical treatment.

Conclusion

Arthroscopic debridement, lavage and irrigation is more promising in decreasing pain, stiffness, and improving physical function more than supervised conservative therapy in patients with grade II & III primary osteoarthritis of the knee joint six to twelve months after the procedure.

KEYWORDS

Osteoarthritis, Arthroscopy, Debridement and lavage, Meniscectomy, Subchondral bone penetration.

References

1. Michael JW, Schluter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int Mar;107(9):152-62.

2. Li G, Yin J, Gao J, Cheng TS, Pavlos NJ, Zhang C, et al. Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes. Arthritis Res Ther;15(6):223.

3. Lane NE, Schnitzer TJ, Birbara CA, Mokhtarani M, Shelton DL, Smith MD, et al. Tanezumab for the treatment of pain from osteoarthritis of the knee. N Engl J Med Oct 14;363(16):1521-31.

4. Kijowski R, Blankenbaker D, Stanton P, Fine J, De Smet A. Arthroscopic validation of radiographic grading scales of osteoarthritis of the tibiofemoral joint. AJR Am J Roentgenol2006 Sep;187(3):794-9.

5. Ronn K, Reischl N, Gautier E, Jacobi M. Current surgical treatment of knee osteoarthritis. Arthritis;2011:454873.

6. Woolacott NF, Corbett MS, Rice SJ. The use and reporting of WOMAC in the assessment of the benefit of physical therapies for the pain of osteoarthritis of the knee: findings from a systematic review of clinical trials. Rheumatology (Oxford) Aug;51(8):1440-6.

7. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med Spring;2(2):205-12.

8. Siemieniuk RAC, Harris IA, Agoritsas T, Poolman RW, Brignardello-Petersen R, Van de Velde S, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ May 10;357:j1982.

9. Katz JN, Brownlee SA, Jones MH. The role of arthroscopy in the management of knee osteoarthritis. Best Pract Res Clin Rheumatol Feb;28(1):143-56.

10. Shannon FJ, Devitt AT, Poynton AR, Fitzpatrick P, Walsh MG. Short-term benefit of arthroscopic washout in degenerative arthritis of the knee. Int Orthop2001;25(4):242-5.

11. Karaman I GA, Kafadar IH, Oner M, Yurdakul E, Turk CY. The Effects of Arthroscopic Joint Debridement in Knee Osteoarthritis Patients Over the Age of Sixty. Erciyes Tıp Dergisi/Erciyes Medical Journal2013;35(3):120-2.

12. Forster MC, Straw R. A prospective randomised trial comparing intra-articular Hyalgan injection and arthroscopic washout for knee osteoarthritis. Knee2003 Sep;10(3):291-3.

13. Casscells SW. What, if any, are the indications for arthroscopic debridement of the osteoarthritic knee? Arthroscopy1990;6(3):169-70.

14. Lyu SR, Hsu CC, Lin CW. Arthroscopic cartilage regeneration facilitating procedure for osteoarthritic knee. BMC Musculoskelet Disord Nov 21;13:226.

15. Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med2008 Sep 11;359(11):1097-107.

16. Shin CS, Lee JH. Arthroscopic treatment for osteoarthritic knee. Knee Surg Relat Res Dec;24(4):187-92.

17. Sokolove J, Lepus CM. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis Apr;5(2):77-94.

18. Jackson RW, Marans HJ, Silver RS. The arthroscopic treatment of degenerative arthritis of the knee. J Bone Joint Surg Br1988;70:332.

19. Xinning LS, A.Franklin,P.Merolli,R. Arthroscopic debridement of the osteoarthritic knee combined with hyaluronic acid (Orthovisc®) treatment: A case series and review of the literature. Journal of Orthopaedic Surgery and Research2008;4(43).

20. Stuart MJ, Lubowitz JH. What, if any, are the indications for arthroscopic debridement of the osteoarthritic knee? Arthroscopy2006 Mar;22(3):238-9.

21. Sedeek SD, AM.Ibrahim,MY. Osteoarthritis of the Knee: Is any Role for Arthroscopy in the Treatment? Current Review. Journal of Current Surgery2014;4(1):1-5.

22. Felson DT. Arthroscopy as a Treatment for Knee Osteoarthritis. Best practice & research Clinical rheumatology2010;24(1):47.

23. Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ Jul 20;354:i3740.

24. Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med2002 Jul 11;347(2):81-8.

25. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med May 02;368(18):1675-84.

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