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Osteoarthritis of the knee

Osteoarthritis of the knee

Does arthroscopy help in osteoarthritis of the knee?

Photo of a woman with knee pain sitting on a bench

Arthroscopy (keyhole surgery) is sometimes recommended for osteoarthritis of the knee. It involves rinsing the knee joint with a solution (lavage) and sometimes also smoothing the cartilage surfaces. But studies have shown that this procedure doesn't help.

In osteoarthritis of the knee, the cartilage covering the surfaces of the knee joint becomes thinner and can no longer properly protect the joint. This causes pain and means you can't move your knee as much. At first, the pain is felt only when the joint is moved, but later on it may also occur when the joint is resting, or at night. If osteoarthritis gets worse, the joint can become stiffer and deformed.

Some doctors recommend treating it with a procedure called knee arthroscopy. But this treatment can’t achieve the often-stated goal of getting rid of – or at least reducing – the symptoms. Plus, it can have side effects and lead to complications like deep vein thrombosis, bleeding, infections and pain. It also takes several weeks to recover from an arthroscopy.

What happens during an arthroscopy?

Arthroscopy is a surgical procedure that is done using a local or general anesthetic. After a small cut is made in the skin and in the joint capsule, an arthroscope is inserted into the knee joint. The arthroscope is a thin, tube-like instrument with a small camera on it that shows the inside of the knee. So arthroscopy can also be used to examine the knee joint.

Arthroscopy isn't typically used for purposes only, though, but also for treatment. A second cut is then made to insert small instruments like scissors or shaver blades into the joint.

When arthroscopy is used for treatment purposes, two things can be done:

  • Lavage (washing out the joint): During lavage, the joint is rinsed with a salt solution. The goal is to remove any loose particles like cartilage or tissue fibers in the joint fluid, and to reduce any inflammation in the joint.
  • Debridement: Debridement involves smoothing rough cartilage surfaces and removing loose bits of cartilage using various instruments. It is followed by joint lavage.

Can arthroscopy help?

Together with researchers from the University of Bern (Switzerland), the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) assessed whether treatment with arthroscopy helps in osteoarthritis of the knee. For this purpose, the group of researchers analyzed the results of eleven studies that included a total of about 1,200 women and men. These studies lasted between 6 and 36 months.

Five studies looked at whether patients who had a knee lavage were doing better than those who did not. In some studies, one group of participants had an arthroscopy while the others only had a "pretend" procedure.

The results of these studies clearly showed that treatment with arthroscopy isn’t effective: After arthroscopy, participants didn’t have less pain or fewer symptoms than those in the "no treatment" comparison group.

The other six studies looked at the effectiveness of treatment with arthroscopy compared with the effectiveness of other treatment options. They didn’t find any advantages there, either.

Brignardello-Petersen R, Guyatt GH, Buchbinder R et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open 2017; 7(5): e016114.

Bucher HC, Glinz D, Gloy V et al. Health Technology Assessment of knee arthroscopy for the treatment of degenerative changes. 2019.

Institute for quality and Efficiency in Health Care (IQWiG, Germany). Arthroscopy of the knee joint for gonarthrosis: Final report; Commission N11-01. 2014.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Does arthroscopy help in osteoarthritis of the knee?

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Updated on August 24, 2021

Next planned update: 2024

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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