Advances in the Canine Cranial Cruciate Ligament, 2nd edition

(^24) Joint Lavage
Peter Muir
Introduction
Pharmacologic treatment of arthritis often
includes systemic or intra-articular admin-
istration of various types of drugs, partic-
ularly anti-inflammatory drugs. Common
intra-articular therapies used for the treat-
ment of arthritis include corticosteroids and
hyaluronic acid (Juni ̈ et al. 2007; Habib 2009).
However, these treatments may be associated
with adverse effects. Relief from arthritic pain
after joint lavage has been noted by surgeons
performing arthroscopy since 1934 (Burman
et al. 1934). Subsequently, it has been sug-
gested that large-volume lavage or irrigation
of joints may facilitate the removal of cartilage
degradation products, inflammatory cells, pro-
inflammatory cytokines, and matrix-degrading
enzymes. However, this remains a provocative
question which has been little considered in
canine orthopaedic surgery.
Clinical studies
To address the question of joint lavage effi-
cacy, a number of clinical trials have been con-
ducted in human patients, principally studying
human knee osteoarthritis patients. Results of
these trials have been conflicting. It has been
suggested that the benefit of joint lavage is due
to a placebo effect (Bradleyet al. 2002). How-
ever, in at least one well-controlled trial, when
arthroscopic debridement was compared with
arthroscopic lavage or placebo surgery, arthro-
scopic procedures did not perform better than
placebo surgery (Moseleyet al. 2002). In other
work, knee arthritis patients undergoing arthro-
scopic lavage have experienced persistent pain
relief for up to 24 weeks (Ravaudet al. 1999).
Comparison of arthroscopic lavage with lavage
plus intra-articular corticosteroids suggested
that little additional benefit is gained from
the use of corticosteroids; benefits from intra-
articular corticosteroids appear short-lived in
the range of 2–4 weeks (Ravaudet al. 1999;
Smithet al. 2003). In at least one study, no inter-
action between steroid injection and joint lavage
was found (Ravaudet al. 1999), suggesting that
joint lavage may have a different and more
persistent mechanism of action than the injec-
tion of corticosteroids. The effects of these two
treatments have also been found to be additive
(Ravaudet al. 1999).
In more recent studies, arthroscopic partial
meniscectomy was compared with diagnostic
arthroscopy (sham surgery) for patients with
a degenerate meniscal tear. Outcomes after
arthroscopic partial meniscectomy were no
Advances in the Canine Cranial Cruciate Ligament, Second Edition. Edited by Peter Muir. © 2018 ACVS Foundation.
This Work is a co-publication between the American College of Veterinary Surgeons Foundation and Wiley-Blackwell.
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