What is the evidence for joint lavage in the treatment of osteoarthritis of the knee?
AMSTAR Rating
Summary
Patient Population:
Participants with knee OA diagnosed by ACR criteria or by radiography. Mean age in treatment groups was reported to be 61.7±6.2 years and 61.5±6.1years in control groups. Slightly more than ½ of the participants in each (51and 53%) were female. 6 parallel-group RCTs were identified for inclusion.
Intervention:
Joint lavage was performed by either one/two needles (3 studies) or by arthroscopy (3 studies). Steroids administered at the end of joint lavage treatment included: cortivasol, methylprednisolone acetate and, triamcinolone, acetonide.
Comparison:
3 studies compared joint lavage vs. placebo, 2 compared combination steroid injection/lavage with lavage alone and 1 compared combined therapy with placebo.
Outcome:
- Pain: joint lavage vs. placebo – non-significant difference in favour of joint lavage (ES=0.17; 95% CI -0.37,0.71).
- Pain: joint lavage vs. joint lavage & steroid injection – non-significant difference in favour of joint lavage alone (ES=-0.82;95%CI -2.47,0.82).
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Joint Lavage vs. Placebo
Pain
Joint Lavage + Steroid Injection vs. Joint Lavage Alone
Pain
Relevant Clinical Info
Moseley, J., et al. (2002). “A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee.” N Engl J Med (347): 81-88.
“At no point did either arthroscopic-intervention group have greater pain relief than the placebo group. For example, there was no difference in knee pain between the placebo group and either the lavage group or the débridement group at one year (mean [±SD] KSPS scores, 48.9±21.9, 54.8±19.8, and 51.7±22.4, respectively; P=0.14 for the comparison with the lavage group, and P=0.51 for the comparison with the débridement group) or at two years (mean KSPS scores, 51.6±23.7, 53.7±23.7, and 51.4±23.2, respectively; P=0.64 and P=0.96, respectively). Similarly, there was no significant difference in arthritis pain between the placebo group and the lavage group or the débridement group at one or two years.”
