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.
Arthroscopy 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.