Reichenbach Stephan, Rutjes Anne Ws, Nüesch Eveline, Trelle Sven, Jüni Peter
Department for Rheumatology, Clinical Immunology, and Allergology, University Hospital, Inselspital, Bern, Switzerland.
Cochrane Database Syst Rev. 2010 May 12(5):CD007320. doi: 10.1002/14651858.CD007320.pub2.
Osteoarthritis is the most common form of joint disorder and a leading 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.
To compare joint lavage with sham intervention, placebo or non-intervention control in terms of effects on pain, function and safety outcomes in patients with knee osteoarthritis.
We searched CENTRAL, MEDLINE, EMBASE, and CINAHL up to 3 August 2009, checked conference proceedings, reference lists, and contacted authors.
We included studies if they were randomised or quasi-randomised trials that compared arthroscopic and non-arthroscopic joint lavage with a control intervention in patients with osteoarthritis of the knee. We did not apply any language restrictions.
Two independent review authors extracted data using standardised forms. We contacted investigators to obtain missing outcome information. We calculated standardised mean differences (SMDs) for pain and function, and risk ratios for safety outcomes. We combined trials using inverse-variance random-effects meta-analysis.
We included seven trials with 567 patients. Three trials examined arthroscopic joint lavage, two non-arthroscopic joint lavage and two tidal irrigation. 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 pain relief at three months (SMD -0.11, 95% CI -0.42 to 0.21), corresponding to a difference in pain scores between joint lavage and control of 0.3 cm on a 10-cm visual 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 degree depending on the type of lavage, but this variation was likely to be explained by differences in the credibility of control interventions: trials using sham interventions to closely mimic the process of joint lavage showed a null-effect. Reporting on adverse events and drop out rates was unsatisfactory, and we were unable to draw conclusions for these secondary outcomes.
AUTHORS' CONCLUSIONS: Joint lavage does not result in a relevant benefit for patients with knee osteoarthritis in terms of pain relief or improvement of function.
骨关节炎是最常见的关节疾病形式，也是疼痛和身体残疾的主要原因。观察性研究表明关节灌洗有益，但最近的假手术对照试验结果相互矛盾，提示关节灌洗无效。
比较关节灌洗与假手术干预、安慰剂或非干预对照对膝骨关节炎患者疼痛、功能和安全性结局的影响。
我们检索了截至2009年8月3日的Cochrane系统评价数据库、医学期刊数据库、荷兰医学文摘数据库和护理学与健康领域数据库，检查了会议论文集、参考文献列表，并联系了作者。
如果研究是随机或半随机试验，比较关节镜和非关节镜下关节灌洗与膝骨关节炎患者的对照干预，我们将其纳入。我们没有设置任何语言限制。
两位独立的综述作者使用标准化表格提取数据。我们联系研究者以获取缺失的结局信息。我们计算了疼痛和功能的标准化均数差（SMD）以及安全性结局的风险比。我们使用逆方差随机效应荟萃分析合并试验。
我们纳入了7项试验，共567例患者。3项试验研究了关节镜下关节灌洗，2项研究了非关节镜下关节灌洗，2项研究了潮式冲洗。方法学质量和报告质量较差，我们在试验中发现了中度至高度的异质性（I² = 65%）。我们几乎没有发现证据表明关节灌洗在3个月时能缓解疼痛（SMD -0.11，95%CI -0.42至0.21），这相当于在10厘米视觉模拟量表（VAS）上关节灌洗组和对照组的疼痛评分差异为0.3厘米。3个月时功能改善的结果相似（SMD -0.10，95%CI -0.30至0.11），这相当于在WOMAC残疾分量表（0至10分）上关节灌洗组和对照组的功能评分差异为0.2厘米。对于疼痛，效应大小的估计在一定程度上因灌洗类型而异，但这种差异可能是由对照干预的可信度差异所解释：使用假手术干预来密切模拟关节灌洗过程的试验显示无效应。关于不良事件和脱落率的报告不令人满意，我们无法就这些次要结局得出结论。
关节灌洗在缓解疼痛或改善功能方面对膝骨关节炎患者没有显著益处。
