PRIMARY OSTEOARTHRITIS OF THE KNEE: COMPARATIVE STUDY BETWEEN ARTHROSCOPIC DEBRIDEMENT AND SUPERVISED MEDICAL TREATMENT FOR THE STAGE (II AND III) OF THE DISEASE

Areewan Mohammed Salih Saeed a and Nabaz Muhammed Ali b



a Department of Surgery, College of Medicine, University of Sulaimani. 
b Department of Surgery, Kalar Hospital, Ministory of Health, Sulaimani, Iraq.



Submitted: 10/10/2017; Accepted: 17/4/2018; Published 1/8/2018
ABSTRACT


Background 

Osteoarthritis is a chronic disorder of synovial joints with progressive softening and disintegration of articular cartilage accompanied by osteophytes, cyst formation, subchondral sclerosis, synovitis and capsular fibrosis, it can be classified into primary and secondary types. Pain is the usual presenting symptom; modalities of treatment includes: physiotherapy, pharmacotherapy and surgery including arthroscopic debridement, osteotomy or arthroplasty.


Objectives 

To assess the effect of arthroscopic debridement in stage II & III primary osteoarthritis of the knee joint and to compare that with the supervised medical therapy.


Patients and Methods

This prospective study was carried out between December 2011 and January 2015, 106 patients with 106 primary knee joint osteoarthritis were included. Age range between 30-60 years, mean (50±7.592); male 43 (40.56%), female 63 (59.43%); male to female ratio was (1:1.45); body mass index (25.50-34.00) mean (29.6375), the right side affected in (48.2%) and left side in (51.8%). The cases were divided into two groups; operative and non-operative group randomly, arthroscopic debridement with lavage in fifty-six patients and supervised medical treatment in fifty patients. Modified WOMAC score were used to evaluate both groups in pre-treatment, one week, one month, 3 months, 6 months and one year after treatment.


Results

In the comparison between the two groups, statistically significant differences were observed at the period of 6 months of treatment while no significant difference observed at the end of one year. Patients assigned to arthroscopic surgery have more improvement in the modified WOMAC score than those assigned to medical treatment. 


Conclusion

Arthroscopic debridement, lavage and irrigation is more promising in decreasing pain, stiffness, and improving physical function more than supervised conservative therapy in patients with grade II & III primary osteoarthritis of the knee joint six to twelve months after the procedure.



KEYWORDS

Osteoarthritis, Arthroscopy, Debridement and lavage, Meniscectomy, Subchondral bone penetration.