About this video
This video looks at surgery for osteoarthritis (often called wear and tear of the joint) when the condition is still problematic and daily life is badly affected. Keyhole (arthroscopic) surgery lets the surgeon look inside the knee, but the video says it does not usually help very much for end-stage osteoarthritis. The video describes a larger operation instead, which realigns the knee or, for older patients in most cases, replaces it. Guidelines also advise against arthroscopy as a treatment for osteoarthritis itself.
Key points
- The video says surgery is considered when the condition is still problematic and the person is very adversely affected in daily life.
- Keyhole (arthroscopic) surgery lets the knee be examined and the condition of the cartilage seen.
- For end-stage osteoarthritis, the video says keyhole surgery does not usually help very much.
- It then describes a larger operation that can change the alignment of the knee joint so that weight moves off the worn area onto an area that is not injured.
- The video says that in most cases for older patients, the knee can be replaced with an artificial one.
- GL: Guidelines advise against arthroscopy as a treatment for osteoarthritis itself: the American Academy of Orthopaedic Surgeons does not recommend arthroscopy with lavage and/or debridement for a primary diagnosis of knee osteoarthritis, and a 2017 BMJ guideline makes a strong recommendation against arthroscopy in nearly all patients with degenerative knee disease.
- GL: One guideline committee recognises a narrow exception, which is not what the video describes. The NICE committee, in the evidence review behind NICE guideline NG226, recognised that arthroscopic procedures are indicated for the treatment of clearly defined mechanical symptoms (due to meniscal tears, loose bodies or other musculoskeletal conditions) that may co-occur with osteoarthritis affecting the same joint. The two situations covered here are loose bodies, and a displaced meniscus tear that is truly obstructing. The mechanical symptoms must be clearly defined. Only a small number of meniscus tears qualify, mainly those that are truly obstructing and displaced (American guideline summary, 2022). Arthroscopy does not treat the osteoarthritis itself.
Questions this video answers
What surgery is used for knee osteoarthritis?
For end-stage osteoarthritis the video describes a larger operation that can realign the knee or replace it. It says keyhole surgery does not usually help very much, and guidelines advise against arthroscopy as a treatment for osteoarthritis itself.
When is a larger knee operation described for osteoarthritis?
The video describes a larger operation for end-stage osteoarthritis. It can change the alignment of the knee joint to move weight off the worn area, or, in most cases for older patients, replace the knee.
