Pain can be a significant and debilitating symptom for patients suffering from osteoarthritis. When medical treatment with pain-relieving medications is ineffective, a physician may recommend surgery. However, clinical trials show that a surgical intervention was no better than a placebo procedure.
According to experts, there are 650,000 surgical procedures performed each year at a significant cost to the consumer. But a clinical study examining the effectiveness of arthroscopic knee surgery for patients with osteoarthritis suggests that traditional surgical treatments were no better than a placebo treatment in their ability to help relieve pain. In addition, the traditionally treated groups did not experience greater improvement in function of the knee compared with the placebo group.
The study, published in the New England Journal of Medicine, randomized 180 patients with osteoarthritis of the knee to receive either arthroscopic debridement, arthroscopic lavage, or placebo surgery. In the placebo group, patients were given a tranquilizer and small incisions were made in the knee but no surgical intervention inside the knee was performed. The point for the study was to evaluate the level of knee pain in all participants for 24 months. The researchers concluded that patients in the placebo group had no greater pain than those who had either of the traditional surgical treatment groups.
What Does This All Mean?
The theory behind debridement and lavage has been to "clean up" cartilage debris in the former and "smooth out" articular surfaces in the latter. All of which might help with joint function and decrease pain. But according to experts, there has never been significant evidence that arthroscopic treatments such as these slows or cures osteoarthritis. Other studies have shown varying results in the ability of these procedures to lessen pain or improve function.
The placebo effect is a well-documented phenomenon in medical literature but not clearly understood. Patients might have a high level of anticipation of a drug or procedure helping them. This, combined with a "suggestibility" and/or a caring physician's recommendations, might in fact help that person to get better even though there has been no actual drug given or procedure performed. On the other hand, the powerful nature of the placebo can also cause patients to have bad effects such as a new or worsening symptom.
Future Recommendations
Shortcomings of the study include the fact that most participants were men, which makes it unfair to extrapolate the results to women. Still, there is more to learn about how we treat osteoarthritis of the knee medically and surgically. Further studies will need to be done to draw any final conclusions. |
