Thousands are having needless knee ops as painkillers 'can be just as effective', say studies

13 April 2012

Pain: Arthritis patients may be better off not having keyhole knee surgery


Thousands of arthritis patients could be needlessly having keyhole knee surgery, claim researchers.

Two studies suggest they may be better off without enduring the procedure.

In fact, one of them found surgery was no better than other treatments at relieving the pain and stiffness of moderate or severe arthritis.

In the UK many patients have arthroscopic surgery either on the NHS or privately to reduce knee pain by tidying up damaged cartilage and ligaments or removing loose debris from the joint.

Guidelines issued earlier this year recommend GPs only refer arthritis patients for arthroscopy when they suffer locking of the knee, not other symptoms.

However, U.S. experts caution that arthroscopy should not be used routinely to treat osteoarthritis.

They add that it may help those with mild symptoms or a recent injury.

One of two studies published yesterday in the New England Journal of Medicine included nearly 200 patients with moderate-to-severe osteoarthritis in the knee.

Researchers at the University of Western Ontario in Canada, gave everyone medication, weekly physical therapy for three months and instruction on twice- daily exercises to do at home.

Half were also given arthroscopic surgery.

Medications included anti-inflammatory drugs and injections of a knee lubricant. Therapy included exercises to strengthen knee muscles and hot and cold packs.

After two years, both groups of patients reported the same pain levels, physical function and overall quality of life. Study co-author Dr Brian Feagan, a professor at the Ontario university, concluded the procedure benefits a minority of patients, those with milder symptoms or large cartilage tears.

In the second study, researchers at Boston University School of Medicine and elsewhere examined MRI knee scans from 991 randomly selected people, aged 50 to 90.

About a third had a tear or other damage to the meniscus – a pair of cartilage pads that act as shock absorbers between the upper and lower leg bones.

But nearly two-thirds who had these tears had no pain or stiffness in the month before the scans.

Some experts think the increased use of MRIs to diagnose knee problems could be leading to unnecessary-surgery or at least referrals to orthopedic surgeons.

‘A lot of people would prefer physical therapy and their doctors would as well,’ said Dr E Anthony Rankin, of the American Academy of Orthopedic Surgeons.

The Arthritis Care charity said it had received calls from patients who had benefited from the procedure.

‘What’s important is to have a climate in which people with osteoarthritis can work with their doctors to find the best outcome for them from the widest range of effective options,’ said a spokesman.

‘We should be extremely cautious about studies which urge stopping or limiting treatments.’  


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