Scientific Article   |    
Effect of Arthroscopic Débridement for Osteoarthritis of the Knee on Health-Related Quality of Life*
Geoffrey F. Dervin, MD, FRCSC; Ian G. Stiell, MD, FRCSC; Kelly Rody, BScN; Jenny Grabowski, MSc
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Investigation performed at the Department of Surgery, University of Ottawa, and the Clinical Epidemiolgy Unit, Ottawa Health Research Institute, Ottawa Hospital, General Campus, Ottawa, Ontario, Canada

Geoffrey F. Dervin, MD, FRCSC
Kelly Rody, BScN
Jenny Grabowski, MSc
Department of Surgery, University of Ottawa, and General Campus, Ottawa Hospital, Suite 5004, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada E-mail address for G.F. Dervin: gdervin@ohri.ca

Ian G. Stiell, MD, FRCPC
Clinical Epidemiology Unit, Ottawa Health Research Institute, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Physicians' Services Incorporated Foundation (95-33) and the Canadian Orthopaedic Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

*A related commentary appears on p. 156 of this issue of The Journal as well as in the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

J Bone Joint Surg Am, 2003 Jan 01;85(1):10-19
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Background: The available evidence supporting the use of arthroscopic débridement for the treatment of symptomatic osteoarthritis of the knee is largely retrospective and lacks validated health-related quality-of-life measures. The goal of the study was to prospectively assess a cohort of patients with osteoarthritis of the knee who were selected for arthroscopic débridement and determine which clinical criteria favor a sustained improvement in health-related quality of life after two years of follow-up.

Methods: One hundred and twenty-six patients with symptomatic primary osteoarthritis of the knee underwent arthroscopic débridement of the knee after failure of medical management. Two groups of surgeons (postgraduate fellows and attending staff) independently evaluated the patients preoperatively with use of a standardized assessment of clinical symptoms and signs and plain radiography. The intervention was arthroscopic débridement, which included resection of unstable chondral flaps and meniscal tears. Abrasion was not performed. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a disease-specific scale, and the Short Form-36 (SF-36), a generic outcome measure.

Results: Sixty-seven (53%) of the 126 patients were female, and the mean age (and standard deviation) was 61.7 ± 8.6 years (range, forty-three to seventy-five years). The medial compartment was more frequently and severely involved, with 57% showing Grade-III or IV involvement, according to the system of Dougados et al. Seventy-nine patients (63%) had an unstable meniscal tear. Fifty-six patients (44%) were rated as having had a clinically important reduction in pain, as determined with the WOMAC pain scale, at two years after the arthroscopic débridement. Physicians were poor at predicting which patients would have improvement. The rate of accuracy of the fellows and staff was 54% and 59%, respectively, and their agreement was only slightly better than chance, with a kappa of 0.27 (95% confidence interval, 0.09 to 0.45). Only three variables were significantly associated with improvement: the presence of medial joint-line tenderness (p = 0.04), a positive Steinman test (p = 0.01), and the presence of an unstable meniscal tear at arthroscopy (p = 0.01).

Conclusions: The prospectively evaluated quality-of-life benefit from arthroscopic débridement of the osteoarthritic knee is less than that reported in previous retrospective surveys on satisfaction. These results may serve as a baseline for comparison against more sophisticated procedures for resurfacing of the articular cartilage. Clinical variables were only partially helpful for predicting a successful result after arthroscopic débridement, and a search for other biologic markers (such as synovial fluid) may be of benefit.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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