BACKGROUND: Osteoarthritis is the most common form of joint disorder and aleading cause of pain and physical disability. Observational studies suggested a benefit for joint lavage, but recent, sham-controlled trials yielded conflicting results, suggesting joint lavage not to be effective.OBJECTIVES: To compare joint lavage with sham intervention, placebo ornon-intervention control in terms of effects on pain, function and safetyoutcomes in patients with knee osteoarthritis.SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE, and CINAHL up to 3 August 2009, checked conference proceedings, reference lists, and contacted authors.SELECTION CRITERIA: We included studies if they were randomised orquasi-randomised trials that compared arthroscopic and non-arthroscopic jointlavage with a control intervention in patients with osteoarthritis of the knee.We did not apply any language restrictions.DATA COLLECTION AND ANALYSIS: Two independent review authors extracted data usingstandardised forms. We contacted investigators to obtain missing outcomeinformation. We calculated standardised mean differences (SMDs) for pain andfunction, and risk ratios for safety outcomes. We combined trials usinginverse-variance random-effects meta-analysis.MAIN RESULTS: We included seven trials with 567 patients. Three trials examinedarthroscopic joint lavage, two non-arthroscopic joint lavage and two tidalirrigation. The methodological quality and the quality of reporting was poor and we identified a moderate to large degree of heterogeneity among the trials (I(2) = 65%). We found little evidence for a benefit of joint lavage in terms of painrelief at three months (SMD -0.11, 95% CI -0.42 to 0.21), corresponding to adifference in pain scores between joint lavage and control of 0.3 cm on a 10-cmvisual analogue scale (VAS). Results for improvement in function at three months were similar (SMD -0.10, 95% CI -0.30 to 0.11), corresponding to a difference in function scores between joint lavage and control of 0.2 cm on a WOMAC disability sub-scale from 0 to 10. For pain, estimates of effect sizes varied to some degreedepending on the type of lavage, but this variation was likely to be explained bydifferences in the credibility of control interventions: trials using shaminterventions to closely mimic the process of joint lavage showed a null-effect. Reporting on adverse events and drop out rates was unsatisfactory, and we wereunable to draw conclusions for these secondary outcomes.AUTHORS' CONCLUSIONS: Joint lavage does not result in a relevant benefit forpatients with knee osteoarthritis in terms of pain relief or improvement offunction.
Joint lavage for osteoarthritis of the knee
Rutjes, Anne;
2010-01-01
Abstract
BACKGROUND: Osteoarthritis is the most common form of joint disorder and aleading cause of pain and physical disability. Observational studies suggested a benefit for joint lavage, but recent, sham-controlled trials yielded conflicting results, suggesting joint lavage not to be effective.OBJECTIVES: To compare joint lavage with sham intervention, placebo ornon-intervention control in terms of effects on pain, function and safetyoutcomes in patients with knee osteoarthritis.SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE, and CINAHL up to 3 August 2009, checked conference proceedings, reference lists, and contacted authors.SELECTION CRITERIA: We included studies if they were randomised orquasi-randomised trials that compared arthroscopic and non-arthroscopic jointlavage with a control intervention in patients with osteoarthritis of the knee.We did not apply any language restrictions.DATA COLLECTION AND ANALYSIS: Two independent review authors extracted data usingstandardised forms. We contacted investigators to obtain missing outcomeinformation. We calculated standardised mean differences (SMDs) for pain andfunction, and risk ratios for safety outcomes. We combined trials usinginverse-variance random-effects meta-analysis.MAIN RESULTS: We included seven trials with 567 patients. Three trials examinedarthroscopic joint lavage, two non-arthroscopic joint lavage and two tidalirrigation. The methodological quality and the quality of reporting was poor and we identified a moderate to large degree of heterogeneity among the trials (I(2) = 65%). We found little evidence for a benefit of joint lavage in terms of painrelief at three months (SMD -0.11, 95% CI -0.42 to 0.21), corresponding to adifference in pain scores between joint lavage and control of 0.3 cm on a 10-cmvisual analogue scale (VAS). Results for improvement in function at three months were similar (SMD -0.10, 95% CI -0.30 to 0.11), corresponding to a difference in function scores between joint lavage and control of 0.2 cm on a WOMAC disability sub-scale from 0 to 10. For pain, estimates of effect sizes varied to some degreedepending on the type of lavage, but this variation was likely to be explained bydifferences in the credibility of control interventions: trials using shaminterventions to closely mimic the process of joint lavage showed a null-effect. Reporting on adverse events and drop out rates was unsatisfactory, and we wereunable to draw conclusions for these secondary outcomes.AUTHORS' CONCLUSIONS: Joint lavage does not result in a relevant benefit forpatients with knee osteoarthritis in terms of pain relief or improvement offunction.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.