A controlled trial of arthroscopic
surgery for osteoarthritis of the knee. Moseley J B, O'Malley K,
Petersen N J et al. N Eng J Med 2002; 347: 81-88.
When medical therapy fails to relieve the pain of
osteoarthritis of the knee, arthroscopic lavage or debridement is often
recommended. In uncontrolled studies of knee arthroscopy for
osteoarthritis, about half of the patients report a reduction in symptoms.
However, the physiological basis of this pain relief is unclear.
There is no evidence that arthroscopy cures or arrests the arthritic
process. The aim of this study was to perform a randomised,
placebo-controlled trial to assess the efficacy of arthroscopic surgery of
the knee in relieving pain and improving function in patients with
osteoarthritis. Both patients and assessors were blinded to the
treatment assignments. Overall, 180 patients with osteoarthritis of
the knee were randomly assigned to receive either arthroscopic
debridement, arthroscopic lavage or placebo surgery. Patients in the
placebo group received skin incisions and underwent a simulated
debridement without insertion of the arthroscope. Outcomes were
assessed at multiple points over a 24-month period with use of five
self-reported scores ( 3 on scales for pain and 2 on scales for function)
and one objective test of walking and stair climbing. A total of 165
patients completed the trial. At no point did patients in either of
the intervention groups report less pain or better function than the
placebo group. Furthermore, the 95% confidence intervals for the
difference between the placebo group and the intervention group excluded
any clinically meaningful difference. It was concluded that in this
controlled trial involving patients with osteoarthritis of the knee, the
outcomes after arthroscopic lavage or arthroscopic debridement were no
better than those after a placebo procedure.
Outcomes of endoscopic surgery compared with open surgery
for carpel tunnel syndrome among employed patients: randomised
controlled trial. Atroshi I, Larsson G-U, Ornstein E
et al. BMJ 2006; 332: 1473-1481.
Surgery for carpel tunnel syndrome is one of the most
performed surgical procedures. The largest proportion are done in
working working people. Open carpel tunnel release may result in
prolonged pain at the scar and in the proximal palm. Endoscopic
procedures have been introduced with the proposed benefit of reduced
postoperative pain and a quicker return to work. The aim of this
study was to compare endoscopic and open carpel tunnel release in employed
patients with carpel tunnel syndrome. A randomised controlled trial
was conducted in a single orthopaedic department, Overall, 128
employed patients aged 25-60 years with clinically diagnoses and
electrophysiologically confirmed idiopathic carpel tunnel syndrome.
The primary outcome measure was the severity of postoperative pain in the
scar or proximal palm and the degree to which pain or tenderness limited
activity. The secondary outcome measures were length of
postoperative work absence, severity of symptoms of carpel tunnel syndrome
and functional status scores. 63 patients were allocated to
endoscopic surgery and 65 patients to open surgery. Pain in the scar
or proximal palm was less severe after after endoscopic surgery but the
differences were generally small. At three months, pain was reported
by 33 patients (52%) in the endoscopic group and 53 patients (82%) in the
open group (number needed to treat = 3.4, 95% CI 2.3-7.7). No
differences between the groups were found in other outcome measures.
The median length of work absence was 28 days in both groups. It was
concluded that in carpel tunnel syndrome, endoscopic surgery was
associated with less postoperative pain then open surgery, but the small
size of the benefit and the similarity in other outcomes makes its cost
effectiveness uncertain.
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