Let's Talk Medicine
A common type of knee surgery to ease pain and clean up worn-out knees may not be worth the time and effort for middle-aged patients, researchers reported Tuesday.
A review of many different studies on arthroscopic knee surgery found it helped for a few months, but not for much longer than that, and had dangerous side-effects including blood clots and infection.
It might be better to treat dodgy knees with weight loss and exercise instead, the researchers write in the British Medical Journal.
“The small, inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time and absent at one to two years after surgery,” Jonas Bloch Thorlund of the University of Southern Denmark and colleagues wrote in their report.
It’s a very common operation, although it’s becoming less and less common as specialists learn that surgery isn’t often the answer. According to the American Orthopaedic Society for Sports Medicine, more than 4 million knee arthroscopy procedures are done worldwide each year; 700,000 in the United States alone.
“Some of this is patient demand,” said Dr. David Teuscher, President of the American Academy of Orthopaedic Surgeons.
And knee pain is common. Americans make more than 5.7 million visits to the doctor for knee pain each year, according to the Centers for Disease Control and Prevention.
But is surgery the answer?
Thorlund’s team looked at nine different studies involving more than 1,200 middle aged or older patients with knee pain and degenerative knee disease who got arthroscopic knee surgery involving partial meniscectomy, debridement, or both. Their assessment: surgery is not helpful.
“When we analyzed pain for different postoperative time points, the benefit favoring arthroscopic surgery was present only at three and six months, but not at later time points,” Thorlund’s team wrote.
And it comes with side-effects. “Harms included symptomatic deep venous thrombosis, pulmonary embolism, infection, and death,” they wrote.
“Taken together, these findings do not support the practice of arthroscopic surgery for middle-aged or older patients with knee pain with or without signs of osteoarthritis,” they concluded.
Teuscher says there are a few situations where surgery is appropriate, but patients don’t need an expensive MRI scan to find out. “You need to get the right kind of x-ray,” he told NBC News. Other than patients with specific injuries or damage, exercise and over-the-counter pain medication may be a better answer.
Dr. Elizabeth Matzkin of Brigham & Women’s Hospital in Boston agrees.
“More often than not, the knee pain can be treated without surgery,” Matzkin writes in a blog post for the American Academy of Orthopaedic Surgeons.
“Obesity causes increased load on the muscles and joints. The knee joint feels five times body weight each step we take — so a weight loss of even five pounds can feel like a 25-pound weight loss to your knee.”
Another recent study found that pain pills such as acetaminophen did little for the knee pain caused by arthritis.
And Teuscher said 15 years ago, surgeons abandoned a procedure called arthroscopic lavage for arthritis because it was shown not to help