Dr. Peter McEwen - M.B.B.S. F.R.A.C.S(Ortho).F.A.Ortho.A.DipModLang - Surgery Knee Dr. Peter McEwen - Surgery Knee: (123) 456789
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The Role of Arthroscopy in Arthritis

The role of knee arthroscopy in the osteoarthritic knee is a controversial one any how any one surgeon approaches this is a very individual thing. The following represents my approach to this issue and should not be taken as a criticism of others.

Black and white situations are easy. As you all know however, our jobs very often involve interpreting shades of grey and in my experience those in the grey zone do not get enough predicatable benefit from an arthroscopy to warrant the time, expense and risks involved. A patient with no arthritis and a huge displaced meniscal tear will get immediate benefit from an arthroscopy and constitutes a white situation. On the other side of the coin someone with advanced OA will get no benefit from a knee arthroscopy and should not be offered one. The grey zone is populated by those with less severe arthritis, with or without a degenerate meniscal tear. The problem is that arthritis is progressive, it accelerates rapidly when associated with meniscal deficiency, even faster if also associated with obesity and malalignment and arthroscopy does nothing to alter any of this. As such an arthroscopy is no better than placebo as treatment for arthritis.

The only situation in which someone with an arthritic knee gets benefit from an arthroscopy is when the primary symptom is locking as opposed to activity related knee pain. Loose bodies, chondral flaps, displaced meniscal tears and meniscal tears causing locking in an arthritic knee are worth treating with an arthroscopy especially if the limb is well aligned and attached to a lean patient. Outside of this scenario an arthroscopy is worse than pointless and should be avoided. Arthroscopy is in no way a substitute for osteotomy or arthroplasty and those who clearly require definitive treatment of their arthritis should not be subjected to an arthroscopy as a temporizing measure. As such, the vast majority of patients referred to me with osteoarthritis are treated non-operatively if their disease and symptoms are mild and definitively with osteotomy or arthroplasty if more severe.

Getting the correct Xrays at the start of the episode of care helps alot. A Rosenberg view is particularly useful in the context of arthritis. See the "Which Xray" document in this section for more information on xrays.

Dr. Peter McEwen - Surgery of Knee
Dr. Peter McEwen - Surgery of Knee
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Arthroscopic Partial Medial Meniscectomy Videos - Dr. Peter McEwen - Surgery of Knee
Australian Orthopaedic Association Royal Australasian College of Surgeons
International Cartilage Repair Society International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine
Crocodiles Orthopaedic Research Institute of Queensland
 

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