aMonash Department of Clinical Epidemiology, Cabrini Institute, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern Victoria bUniversity of Sydney, Institute of Rheumatology and Orthopedics, Royal Prince Alfred Hospital, Camperdown New South Wales cSouth Western Sydney Clinical School, University of New South Wales, Liverpool New South Wales, Australia.
Curr Opin Rheumatol. 2014 Mar;26(2):138-44. doi: 10.1097/BOR.0000000000000022.
Over the last decade, there has been increased recognition of the importance of high-quality randomized controlled trials in determining the role of surgery for knee osteoarthritis. This review highlights key findings from the best available studies, and considers whether or not this knowledge has resulted in better evidence-based care.
Use of arthroscopy to treat knee osteoarthritis has not declined despite strong evidence-based recommendations that do not sanction its use. A large randomized controlled trial has demonstrated that arthroscopic partial meniscectomy followed by a standardized physical therapy program results in similar improvements in pain and function at 6 and 12 months in comparison to physical therapy alone in patients with knee osteoarthritis and a symptomatic meniscal tear, confirming the findings of two previous trials. Two recent randomized controlled trials have demonstrated that decision aids help people to reach better-informed decisions about total knee arthroplasty. A majority of studies have indicated that for people with obesity the positive results of total knee arthroplasty may be compromised by postoperative complications, particularly infection.
More efforts are needed to overcome significant evidence-practice gaps in the surgical management of knee osteoarthritis, particularly arthroscopy. Decision aids are a promising tool.
在过去的十年中，人们越来越认识到高质量的随机对照试验对于确定膝关节骨关节炎手术治疗的作用的重要性。本综述重点介绍了现有最佳研究的主要发现，并考虑了这些知识是否带来了更好的循证护理。
尽管有强有力的循证医学建议不支持关节镜手术的应用，但关节镜治疗膝关节骨关节炎的应用并未减少。一项大型随机对照试验表明，对于膝关节骨关节炎伴半月板撕裂症状的患者，与单独接受物理治疗相比，关节镜下半月板部分切除术加标准化物理治疗方案在 6 个月和 12 个月时在疼痛和功能改善方面的结果相似，这证实了两项先前试验的结果。最近的两项随机对照试验表明，决策辅助工具可以帮助人们做出关于全膝关节置换术的更明智决策。大多数研究表明，对于肥胖患者，全膝关节置换术的积极结果可能会因术后并发症（尤其是感染）而受到影响。
需要进一步努力来克服膝关节骨关节炎手术治疗中存在的明显证据与实践之间的差距，特别是在关节镜治疗方面。决策辅助工具是一种很有前途的工具。
