Two studies call into question whether many people with arthritis are needlessly undergoing one of the most common operations in America: arthroscopic knee surgery.
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One finds that surgery is no better than medicine and physical therapy for relieving the pain and stiffness of moderate or severe arthritis. The other reveals that tears in knee cartilage — which often prompt such surgeries — are common without causing symptoms.
Experts said the new studies and other evidence show arthroscopic knee surgery still has a place, such as after a recent injury, but shouldn't be done routinely for osteoarthritis.
"A lot of people would prefer physical therapy, and their doctors would, as well,” said Dr. E. Anthony Rankin, spokesman for the American Academy of Orthopedic Surgeons.
The studies were published last week in the New England Journal of Medicine.
Nearly 27 million Americans have osteoarthritis, a top cause of disability. Symptoms usually begin after age 40 and progress as a breakdown of cartilage on the end of bones causes them to rub together at joints, leading to stiffness and pain, and limiting movement.
One popular solution is arthroscopic surgery, in which a scope with a miniature camera is inserted through a tiny incision, and surgeons operate through other tiny cuts. Surgeons typically smooth damaged cartilage surfaces on the bone's ends and flush out bone chips. This allows quicker healing than traditional surgery but can still trigger blood clots, infection, and nerve or blood vessel damage.
About 1 million arthroscopic knee surgeries are done in this country each year, costing roughly $7,000 apiece, depending on the location, when done as an outpatient procedure.
A large study in 2002 found the operation was no better than sham surgery, but the procedure remains popular.
The new study, done at the University of Western Ontario in Canada, included nearly 200 patients with moderate-to-severe osteoarthritis in the knee. Researchers gave half medicine, weekly physical therapy for three months and instruction on twice-daily exercises to do at home. The other half got those treatments plus arthroscopic surgery.
Medicines included anti-inflammatory drugs, Tylenol, glucosamine or chondroitin supplements 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 meniscus tears. He predicted the study would change standard practices.
In the other study, researchers at Boston University School of Medicine and elsewhere examined magnetic resonance images of knees from 991 randomly selected people ages 50 to 90, from Framingham, Mass. About one-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 knee cartilage tears had no pain or stiffness in the prior month.
Some experts say the increased use of MRIs to diagnose knee problems could be leading to unnecessary surgeries or at least referrals to orthopedic surgeons. Surgery for that problem "probably isn't terribly helpful compared to just medication and physical therapy,” said Dr. C. David Geier Jr., a spokesman for the American Orthopaedic Society for Sports Medicine.
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Protecting joints from arthritis
Here are ways to protect your joints from osteoarthritis or slow its progression:
•Lose weight. Excess weight stresses hips, knees and other joints; every pound lost reduces the load exerted on the knee by 4 pounds for each step.
•Get active. Exercise strengthens muscles around joints, which can prevent cartilage from wearing down.
•Stay straight. Good posture protects the neck, back, hip and knee joints.
•Don't sit still. Switching positions can decrease joint and muscle stiffness.
•Lift carefully. Use your biggest and strongest joints and muscles when lifting or carrying to avoid straining smaller joints.
•Break it up. Rest between periods of heavy activity to prevent repetitive stress on joints that can accelerate wear and tear.
•Don't overdo it. Get help for any job that's too physically demanding. Don't be a "weekend warrior” by jumping into sports your body isn't prepared to handle.
Source: Arthritis Foundation
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