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Study: Knee Surgery No Better Than Conservative Treatments

Posted by Chrissie Cole
Thursday, September 11, 2008 10:09 AM EST
Category: Major Medical
Tags: FDA & Prescription Drugs, Knee Surgery, Medical Devices and Implants, Osteoarthritis, Arthritis

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IMAGE SOURCE: © Wikimedia Commons / knee diagram / author: Mysid

Arthroscopic knee surgery is no better than conservative treatments to relieve knee pain caused by arthritis, according to a newly release study by researchers from the University of Western Ontario in Canada.

An estimated 27 million American suffer from pain and stiffness associated with osteoarthritis, the most common form of arthritis, caused by the breakdown of cartilage in the joints.

The study involved a total 172 men and women split into two groups, all who had moderate to severe osteoarthritis of the knee, over two year period.

The study found 86 patients who underwent knee surgery fared no better than 86 patients who had physical therapy and took medications (such as ibuprofen or acetaminophen) to help control pain and inflammation.

The arthroscopic knee surgery did little by way of improving joint function or reducing pain.

A study conducted in 2002, by the Department of Veterans Affairs, also published in NEMJ, came to a similar conclusion. Although, they had a slightly different plan: rather than assign patients to medical treatment or surgery, they were assigned to real operation or a placebo procedure. The real operation fared no better than the placebo procedure.

That study was criticized by many orthopedic surgeons, but Medicare stopped paying for the surgery in 2003. Yet, still, because doctors can modify what is wrong with the patient, they can still receive reimbursement – making it unclear if most doctors stopped performing the surgery, or how many surgeries were still being performed.

The surgery involves making a small incision in the patient’s knee, inserting a small camera to see the joint and then flushes debris from the knee or shaves rough areas of cartilage to clean the area surrounding the joint.

It made sense that the debris and rough areas were both contributing factors to knee pain, so when the department study found the operation useless, many simply denied it.

“We now have two independent, well-controlled studies that demonstrate the procedure is ineffective,” said Brian Feagan, one of the researchers involved in the newly published Canadian study. “This will study will likely change practice.”

Patience White, chief public health officer for the Arthritis Foundation, said that, at the very least, the study finding will make more patients and physicians try other therapies before considering surgery. “Before, it would have been the first choice of many surgeons.”

In accompanying commentary within the journal, Robert G. Marx, an orthopedic surgeon at Weill Medical College of Cornell University, said the study showed “strong evidence” for the conclusion that “arthroscopic surgery is not effective means of therapy for advanced osteoarthritis of the knee.”

But, he noted, knee surgery may still be a good option for those patients with knee problems in addition to osteoarthritis.

The study is published in the September 11 issue of the New England Journal of Medicine. #


3 Comments

Anonymous User
Posted by Bert drass
Thursday, September 11, 2008 10:54 AM EST

I have been running for 38 years. In 1980 I had severe left Knee pain and had a minisectomy performed. Within three to four weeks after the procedure I was back running regularly. In 1989 I experienced the same problem with my right Knee and did the same for it. Two months later I ran a Marathon and have been running regularly since with no knee problems. I am 68 yrs old and will attempt to continue running until I die. So while knee surgery may not be for everyone it certainly worked for me.

Posted by D Hill
Thursday, September 11, 2008 11:17 AM EST

This article only mentions that arthroscopic knee surgery is not effective for osteoarthritis. It does not suggest that surgery should not be performed if you have a meniscus tear, torn cartilage, and the like.

Anonymous User
Posted by mbeuthin
Thursday, September 11, 2008 12:02 PM EST

good point, D Hill. I had this surgery when I was a senior in high school for a torn lateral meniscus from playing volleyball. It was 100% not helpful. I still experience the same pain in my knee, and it's easily inflamed from mild exercise. Just walking or steps causes it to stiffin/swell, the same as before the surgery. I've always thought that surgery was unecessary and I've been waiting for someone to figure it out and print this.

Comments for this article are closed.

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