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Knee osteoarthritis and role for surgical intervention: lessons learned from randomized clinical trials and population-based cohorts

Buchbinder, Rachellea; Richards, Bethanb; Harris, Ianc

Current Opinion in Rheumatology: March 2014 - Volume 26 - Issue 2 - p 138–144
doi: 10.1097/BOR.0000000000000022
EPIDEMIOLOGY AND HEALTH-RELATED SERVICES: Edited by Allan C. Gelber
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Purpose of review Over the last decade, there has been increased recognition of the importance of high-quality randomized controlled trials in determining the role of surgery for knee osteoarthritis. This review highlights key findings from the best available studies, and considers whether or not this knowledge has resulted in better evidence-based care.

Recent findings Use of arthroscopy to treat knee osteoarthritis has not declined despite strong evidence-based recommendations that do not sanction its use. A large randomized controlled trial has demonstrated that arthroscopic partial meniscectomy followed by a standardized physical therapy program results in similar improvements in pain and function at 6 and 12 months in comparison to physical therapy alone in patients with knee osteoarthritis and a symptomatic meniscal tear, confirming the findings of two previous trials. Two recent randomized controlled trials have demonstrated that decision aids help people to reach better-informed decisions about total knee arthroplasty. A majority of studies have indicated that for people with obesity the positive results of total knee arthroplasty may be compromised by postoperative complications, particularly infection.

Summary More efforts are needed to overcome significant evidence-practice gaps in the surgical management of knee osteoarthritis, particularly arthroscopy. Decision aids are a promising tool.

aMonash Department of Clinical Epidemiology, Cabrini Institute, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern Victoria

bUniversity of Sydney, Institute of Rheumatology and Orthopedics, Royal Prince Alfred Hospital, Camperdown New South Wales

cSouth Western Sydney Clinical School, University of New South Wales, Liverpool New South Wales, Australia

Correspondence to Professor Rachelle Buchbinder, Monash Department of Clinical Epidemiology, Suite 41 Cabrini Medical Centre, 183 Wattletree Road, Malvern Victoria 3144, Australia. Tel: +61 3 9508 1652; fax: +61 3 9508 1653; e-mail: rachelle.buchbinder@monash.edu

© 2014 Lippincott Williams & Wilkins, Inc.