Wednesday, February 3, 2016

Is Joint Lavage Effective for Osteoarthritis of the Knee?

Lavage is a medical term that basically means the washing, rinsing or cleansing of any area.  Arthroscopic lavage is one of the several medical procedures that are available, to aid in the reversal of permanent damage in patients that have early signs of arthritis.  This type of treatment is controversial, especially in older patients that have established arthritis.

Almost 50 years ago, it was very common for arthritic patients to undergo a procedure using joint lavage.  This type of treatment is no longer recommended for osteoarthritis of the knee.
When cartilage breaks down, tiny pieces of tissue and cartilage can be left in the joint, and crystallization can occur within the joint.  Joint lavage is the procedure that will “wash out” and remove the debris that may have collected in the joint space.  This procedure involves inserting one or more tiny tubes into the joint.

There are several types of joint lavage:

1. Tidal Irrigation:
This process uses only one tube to inject and remove fluid from the joint.

2. Non-arthroscopic:
This process uses two points of entry, one to inject fluid and the other to remove fluid from the joint.  There is no visual inspection of the joint with this procedure.

3. Arthroscopic:
This is a process that requires a visual viewing and inspection of the joint.
During a joint lavage procedure, saline (salt and water solution) is injected into the joint, to loosen and wash out debris.  Then the joint is drained of fluid.  This is a process that can be repeated several times.  The theory behind this treatment, is that by removing the debris in the joint, the inflammation and chronic pain associated with osteoarthritis will be reduced.    There is some conflict as to the effectiveness of this type of treatment.

A study on arthritis and rheumatism was conducted on about 100 patients with tibiofemoral knee osteoarthritis. They were each randomly assigned four (4) different treatments (placebo, intraarticular corticosteroids, joint lavage with corticosteroids, and joint lavage with placebo)  Results from this study showed that when corticosteroids was used, pain was significantly reduced.  Test subjects that received the joint lavage with corticosteroids treatment, enjoyed up to six (6) months of reduced arthritis and joint pain.

A study published in the American Academy of Orthopedic Surgeons (AAOS) offered more than 20 recommendations for knee osteoarthritis, and joint lavage did not make the list.  The AAOS is not convinced, that there is enough evidence, to warrant the recommendation of this type of treatment.
There doesn’t seem to be any high-quality medical studies conducted around joint lavage, and what has been studied, shows that this treatment is just as effective, like steroid injections.  In two separate trials, lavage did not prove to be a better treatment than 10 ml injections of saline.  Some studied results show, that patients that were injected with hyaluronic acid experienced significantly lower pain, than patients that were treated with lavage.

The “Annals of Rheumatic Diseases” published another study that showed, that not only are there not enough benefits to support treatment with a joint lavage, but that complication with this type of procedure are possible.

Infection is always a risk, when any procedure using needles are involved.  Another complication that may develop is pseudo-gout, and this is similar to gout.  Basically, pseudo-gout is a type of arthritis that causes sudden swelling in your joints, and it is incredibly painful.  These episodes can last from a few days to a few weeks, and it is most commonly known to affect the knee joint.

More than twenty (20) million people living in the United States are afflicted with osteoarthritis (OA), and more than 11% have this type of pain in their knees.  Osteoarthritis is diagnosed using medical history information, conducting a physical exam and performing tests, such as radio logic imaging.

The American College of Rheumatology has derived an algorithm, to properly diagnosis osteoarthritis of the knee.  It should be the presence of chronic pain, and should match several of the following points:

1. Patient must be older than 50.
2. Stiffness, upon walking lasts no longer than 30 minutes.
3. Tenderness.
4. Swelling.
5. The presence of non-inflammatory synovial fluid.
6. The grating sound when the joint is moved.
7. The bone is abnormally enlarged.

The main purpose of treating osteoarthritis is to reduce pain and improve mobility.  But many treatments are not considered to be curative.  Some effective, non-surgical, treatments include, (but are not limited to): exercising, losing weight, using an aid (such as a cane) to get around, taking over-the-counter pain meds, such as ibuprofen, and supplements, such as chondroitin and glucosamine are also said to be effective treatments for reducing joint pain.

Invasive treatment may be a consideration, especially if the above non-surgical treatments are not effective.  Some operative treatments may include, osteotomy, cartilage debridement, arthroscopic lavage and total arthroplasty of the joint.


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