Arthroscopic Knee Surgery ‘No Benefit’ for Osteoarthritis

Arthroscopic Knee Surgery ‘No Benefit’ for Osteoarthritis

Arthroscopic knee surgery provides no benefit to patients with osteoarthritis, and does not relieve pain any better than physical therapy or over-the-counter pain medications, according to a new report by a German health organization.

512px-ACLI_121-300x241Arthroscopy of the knee joint is an endoscopic procedure in which a surgeon inserts a thin tube with a camera through a small incision in the skin to view the inside of the knee. The surgeon removes damaged cartilage and loose bone by flushing the knee joint with saline solution. The goal of the procedure is to relieve pain and improve joint flexibility, but researchers found little evidence that they do either.

“The benefit of therapeutic arthroscopy for the treatment of gonarthrosis (knee osteoarthritis) is not proven. There was no hint, indication or proof of a benefit of therapeutic arthroscopy for any patient relevant outcome in comparison with no active comparator intervention,” said the German Institute for Quality and Efficiency in Health Care.

“There was also no hint, indication or proof of a benefit of therapeutic arthroscopy for any outcome in the comparisons with lavage, oral administration of NSAIDs, intraarticular hyaluronic acid injection or strengthening exercises under the supervision of a physical therapist.”

Osteoarthritis (OA) is the most common form of arthritis, and affects more than 27 million Americans and over 100 million people worldwide. OA is a chronic degenerative joint disease that causes pain and swelling of joints in the hand, hips, or knee. OA of the knee is more prevalent and severe in women, elderly and the obese.

German researchers reached their conclusion about the ineffectiveness of arthroscopy after studying 11 randomized controlled trials involving over 1,000 OA patients who had the procedure or a “sham surgery” that was used as a placebo to mimic arthroscopy.

“No benefit of therapeutic arthroscopy in comparison with sham surgery and no treatment could be derived from most study results,” the Institute said in a statement. “It was already known that invasive treatment methods often have a particularly strong placebo effect. However, the extent of improvement perceived by the patients after placebo arthroscopy in these studies was surprising.”

The American Medical Society for Sports Medicine (AMSSM) listed arthroscopic surgery as one of five procedures that are commonly ordered but not always necessary in sports medicine as part of the Choosing Wisely campaign, an initiative of the ABIM Foundation. The AMSSM advised physicians to avoid recommending knee arthroscopy as an initial treatment for patients with degenerative meniscal tears.

A large 2012 study in Australia also questioned the value of arthroscopic knee surgery, finding there was no significant benefit for OA patients.

Arthroscopic knee surgery costs about $4,000, depending on insurance, hospital fees and the surgeon.

A 2013 study published in JAMA found that a combination of diet and exercise was more effective than medication in reducing pain in overweight patients who suffer from knee osteoarthritis. Nearly 40 percent of the patients enrolled in an intensive weight loss and exercise program had little or no knee pain after 18 months. They also had better mobility, joint function and quality of life.

Authored by: Pat Anson, Editor

There are 2 comments for this article
  1. Stephen S. Rodrigues, MD at 7:50 am

    Once a standard of care procedure is set in motion changing them are difficult.
    When the old or failed standard of care options we have to be replaced with one that is more effective, that would mean we would have to figure out why the first one failed and find one that is better.

    Why are providers still performing these procedures despite the negative evidence?
    How did it get started? Why did it fail? What are other options?

    If failed due to a few flaws in the medical and human logic that is the cause of these factors. These flaws in medical logic is effecting everyone’s health and wellbeing. They are even adding to the overall cost of healthcare. Because they are ubiquitous in medicine and a part of human nature, that makes them inconceivable to some. Once you visualize and experience a few key points, the flaws may become clearer but it will still take a lot of time for the shift in thought.

    Pain is not what or where we think it is. So how can we address or treat pain?
    Pain apparently can not be completely treated with surgery. So why do we think we can fix or repair pain?
    Pain apparently can not be seen on a scan, MRI, or even with our naked eye through the arthroscope. So where is pain?
    Pain apparently is not all in the head because we know people are telling us the truth.
    So where is this pain?

    This type of pain is right under our noses within our flesh and is a function of the human body. Aches, pains and stiffness are a part of human existence. So why are we in pain?

    We stopped treating pain with what we used a few decades and centuries ago. This is what we in the Alternative and Complementary Medicine are attempting to reestablish in this high-tech world. In the CAM world there are valuable truths that are drowned out by the raw scientist who dispel any treatment that defies human logic. Here are the best options and all must be used as a way of life and not as a quick fix.

    Research Myofasical Release Therapies: I visualize all these therapies on a spectrum; Self care. wellness, magnesium, simple stretching, yoga, massage, cranio-sacral, Rolfing, Active Tissue Release, Myofascial Unwinding and Chiro adjustments. If needed, step up to Acupuncture and all of its various types, dry needling, Gunn-Intramuscular Stimulation, Travell/Simons-Rachlin wet/lidocaine needling, Hackett-prolotherapy to other hypodermic needling with various substances and other hypodermic injections.

  2. Kimberly Kay Miller at 2:08 pm

    I am so glad I under went this excruciatingly painful surgery for no good reason. Along with the epidural fiasco, this is all in an attempt to keep from giving out those terrible pain pills. Well, my knee still hurts, probably always will, and nobody sticking three tubes in it is ever going to stop that.

    See Link for Opposition to Kentucky HB 1 “Pill Mill Bill”

    https://www.facebook.com/pages/Opposition-to-Kentucky-HB-1-Reform-HB-217-aka-Pill-Mill-Bill/595049517218134