Arthroscopic Knee Surgery Questioned

Arthroscopic Knee Surgery Questioned

The use of arthroscopic surgery is a common practice, but for patients with osteoarthritis of the knee, it may be an ineffective and unnecessary procedure  according to new study published in the Medical Journal of Australia.

After looking at the results of more than 800,000 patients, researchers found that doctors continued to perform the surgery on patients with osteoarthritis (OA) , and that the rate of the procedure over a nine year period remained steady, despite numerous studies that show no significant benefit from the operation.

“Because arthroscopic procedures can be associated with complications, it is important that they are used only when they are likely to have measurable positive outcomes”, the authors of the study wrote.

“Given the uncertain evidence of effectiveness, general practitioners should encourage patients with OA of the knee who have no evidence of major mechanical derangement to try non-surgical treatments in the first instance.”

Osteoarthritis is the most common joint disorder, caused by aging and wear and tear on a joint. Before age 55, it occurs equally in men and women, but after age 55, it is more common in women. Pain and stiffness in the joints are the most common symptoms. The pain is often worse after exercise and when patients put weight or pressure on the joint.

For milder cases of OA, the Australian study recommends that doctors and patients use a conservative approach, focusing on physical therapy, pain relievers like acetaminophen and non-steroidal anti-inflammatory drugs, and a regimen of self-management strategies.

According to the National Institute of Health (NIH), those strategies should include life style changes such as staying active and exercising regularly to help maintain joint and overall movement, along with eating a healthy balanced diet and watching your weight.

The NIH also encourages the use of physical therapy which it says can help improve muscle strength and the motion of stiff joints, as well as your sense of balance.

“OA cannot be cured.” the NIH writes. “It will most likely get worse over time. However, your OA symptoms can be controlled. You can have surgery, but other treatments can improve your pain and make your life much better. Although these treatments cannot make the arthritis go away, they can often delay surgery.”

But the Australian researchers discovered that getting some doctors to change their preference to perform surgery is difficult, and that despite the published evidence, the personal clinical experience of orthopedic surgeons in arthroscopic procedures is encouraging them to continue their use.

They also found that surgical options were preferred by some patients, causing a dilemma for doctors who do not wish to limit patient choice, despite the uncertain clinical evidence of the benefit of knee arthroscopy.

In an accompanying editorial in the Medical Journal of Australia, Professor Rachelle Buchbinder, director of Monash Department of Clinical Epidemiology, Cabrini Health and Professor Ian Harris from the South Western Sydney Clinical School, University of New South Wales wrote that it was difficult to “shift the convictions of many surgeons”.

They wrote that in contrast to new drugs, promising new surgical interventions continued to be introduced into practice before their proper evaluation.

“The use of arthroscopy for knee osteoarthritis has been allowed to continue, exposing patients to an intervention that is at best ineffective, and at worst, harmful,” they wrote.

Authored by: Richard Lenti