Are We Wasting Billions on Arthroscopic Knee Surgery?

July 21, 2017

By Best Doctors

Arthroscopic knee surgery is commonly performed to alleviate chronic knee pain. Doctors send a tiny camera, called an arthroscope, through an incision in the knee to see inside and operate accordingly. Depending on the damage, doctors may, for example, realign a kneecap or repair a torn meniscus. This common orthopedic procedure is done on over 1 million patients annually in the US and costing over $5 billion. But does it relieve knee pain?

New evidence on a common treatment

A new study, led by Dr. Reed Siemieniuk, an internist in Toronto and a PhD student in health research methodology at McMaster University in Hamilton, Ontario, suggests otherwise. An international panel of physicians, physiotherapists, academics and patients reviewed 13 different trials of about 1,700 patients and control groups.

Dr. Siemieniuk explains there are certain instances where arthroscopic surgery is useful, such as traumatic knee injuries. For chronic pain caused by other conditions, like arthritis or another degenerative knee disease, researchers found the surgery has no long-term benefits for pain, function or quality of life. In many cases, a meniscus tear isn’t the cause of knee pain, and repairing it won’t cure the underlying arthritis.

In Ontario alone, the panel found 90 percent of surgeries done in 2013 were due to arthritis. The analysis and clinical practice guidelines were published in the BMJ. “It’s minimally invasive. It generally has low risk. But that said, if it’s not helping people in the long run, then even small risks can become important when it’s so common,” Dr. Siemieniuk says. These consequences can include two to six weeks of recovery time, and even blood clotting or infection.

Though evidence casting doubt on arthroscopic knee surgery began emerging in the last decade or so, physicians often recommend it to their patients. In 2002, a team of researchers looked at a randomized trial of elderly veterans with osteoarthritis and found arthroscopic surgery wasn’t more effective in relieving pain than placebo surgery, which involves making an incision in the knee but not performing surgery. In 2014, Dr. Moin Khan, research fellow at McMaster University, and team looked at 804 patients in randomized control trial spanning from 1946 to 2014. They also found little difference in long-term results for middle-aged or older patients between arthroscopic surgeries and placebo surgeries.

A better solution to knee pain

Dr. Siemieniuk admits that there are no easy answers for chronic knee pain: “The problem is that none of the current options cure the pain. Most people will continue to live with some pain even with weight loss, physical therapy, and painkillers. Knee replacement surgery also has important limitations and should be delayed as long as possible. So it’s no surprise that many placed their hopes in arthroscopic knee surgery.”

Now, Dr. Siemieniuk says it’s up to both health policymakers and physicians to decide to how to discourage further surgeries. In the long term, patients are likely to need knee replacement surgery. Before that, alternative treatments to surgery, according to U.S. News Healthcare, include:

  • Exercise and weight loss—Because extra weight puts extra stress on joints, studies have shown those who are overweight are 30 percent more likely to develop osteoarthritis, and losing weight helped reduce pain and improve function.
  • Physical therapy—Pain levels are directly related to muscle weakness, so strengthening the muscles, specifically quadriceps, can reduce pain.
  • Medication—Though medications come with the risk of side effects, anti-inflammatory drugs, Capsaicin skin creams and COX-2 inhibitors have shown to be effective in some patients.
  • Glucosamine and chondroitin sulfate—These dietary supplements can help with osteoarthritis pain and inflammation. However, because the FDA doesn’t regulated supplements, quality can vary.
  • Vicosupplementation—Hyaluronic acid is naturally found in the knee, so supplementing injections have been beneficial in lubricating joints and absorbing shock in some patients.

It’s important to note there will still be exceptions to these guidelines. Certain patients, with minor arthritis and large tears, for example, may benefit from arthroscopic knee surgery. Patients should always partner with their physicians to find the best treatment and get a second opinion if they’re questioning any part of the diagnosis or treatment.

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