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Knee Surgery Useless, Study Shows

Bad news for creaky Baby Boomers: There's strong new evidence out that arthroscopic surgery is useless for arthritis of the knee.

Researchers at the University of Western Ontario in Canada studied 178 men and women suffering from moderate to severe arthritis in their knees. The patients all got standard medical treatment, including physical therapy, painkillers such as acetaminophen and ibuprofen, glucosamine supplements and injections to lubricate the joint. Eight-six of the patients also underwent athroscopic surgery, which involves inserting instruments through tiny incisions to clean out any loose debris and smooth out the joint.

Tests done every six months for the next two years showed that both groups improved, reporting less pain and stiffness and more mobility. But the patients who did not get surgery did just as well as those who got the operations, the researchers report in tomorrow's issue of The New England Journal of Medicine.

This isn't the first time researchers are questioning the operations, which are done on thousands of Americans each year. In 2002, another study found the operations were no better than a sham procedure. A year later, based on that and other studies, Medicare stopped paying for operations for severe arthritis of the knee, and the number of claims for the procedure dropped dramatically. But the 2002 study was criticized as flawed--all the operations were done by one surgeon and the subjects were all men and tended to be older than the typical patient. And many surgeons continued to do them. In fact, some estimate that as many as 300,000 of the procedures are still being done each year in the United States.

Brian Feagan, who led the new research, says his study doesn't have those shortcomings--it involved both men and women and patients who were 60 years old on average, which is more typical.

Now, Feagan and others stress that surgery can help people who have problems other than arthritis, such as a torn cartilage or ligament. But Feagan and others say they hope the new research will encourage surgeons to be much more selective in choosing patients for the operations, and patients will be less aggressive about demanding it if arthritis is their main problem. They're a waste of money and unnecessarily expose patients to the risks that go along with any kind of surgical procedure.

But it's unclear whether this study will settle the debate. In an editorial accompanying the study, Robert Marx of the Hospital for Special Surgery in New York argues that this study also has some weaknesses and there may be some patients who might benefit, such as patients with arthritis and torn cartilage.

By Rob Stein  |  September 10, 2008; 5:00 PM ET
Categories:  Nutrition and Fitness , Seniors  
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My four year old titanium knee, on the other hand, is working just fine!

Posted by: Helena Montana | September 10, 2008 8:47 PM | Report abuse

I guess the author of this study expects orthopedic surgeons and the groups they belong to stop making a living by doing arthroscopic surgery on arthritic knees - not a chance!

I've worked with physicians in virtually every specialty group in regards to billing and negotiation of health plan contracts. Of those physicians, I would say orthopedic surgeons without question are the most financially aggressive.

The only thing that will slow the pace of these surgeries is if health plans follow Medicare's lead and start refusing to pay for them. And if I know health plans - and I do - it will start happening very soon. I'd look for large national payers like Aetna, Cigna, and United Healthcare to lead the charge.

Posted by: Tom | September 10, 2008 9:05 PM | Report abuse

Procedures pay! The more procedures available to a specialty or sub specialty, the more money one makes. Cognition is not rewarded so that thinking about and speaking with a patient is becoming a lost art. Incidentally, specialties like internal medicine and family medicine are attracting fewer people because of the financially relatively unrewarding challenges. This joins a long list of medical procedures which may have some use but are more often abused by those whom we trust to use them appropriately. It will not be stopped voluntarily because of the range of people who "benefit" from it, from manufacturers to hospitals and a host of others. The one gaining the least is the patient.

Posted by: Draesop | September 10, 2008 10:04 PM | Report abuse

Arthroscopy is simply surgery performed with an arthroscope. There are numerous surgeries performed with an arthroscope, in the knee and every other joint.

Not until the end of the 7th paragraph does the story explain exactly what surgical procedure was studied--debriedement. This is the removal of loose bits of debris using an arthroscope.

How many people understand this from reading the story? Almost none. How many people are going to to say "it doesn't work" when a doctor mentions arthroscopy, regardless of the actual procedure being discussed?

Posted by: surgically literate | September 11, 2008 12:34 AM | Report abuse

My othro doc sited the same information almost 3 years ago. I had a bone chip removed from my knee last summer and a debriedement at the same time. That knee does not require "icing down" every time I excercise like my other knee. This is just one person's opinion, but the debriedement worked well for me. I am considering asking my otho doc to "do" the other knee before insurance companies deny this procedure.

Posted by: beentheredonethat | September 11, 2008 8:27 AM | Report abuse

To say that medications work for everybody is a stretch. This leaves those people with two options: suffer or pay for it themselves. You can't get by for any surgery for less than 25 grand these days.

There needs to be a third option. A demonstrated failure of medication in a patient should permit surgery.

There is no question the procedure works for some people.

Unfortunately Medicare (and others to follow) have decided that suffering is what should happen-- no exceptions.

Posted by: Brian | September 11, 2008 8:41 AM | Report abuse

You have to read the article above very carefully to see that it is only talking about this procedure's usefulness in relation to arthritis. So, for the person who posted about the bone chip, it's not same and it's not surprising that it worked for your knee problem. I have torn and deteriorating cartilege in my knees from years of running and I will probably have a debriedement in the next couple of years. I expect it will work for me too, but then, I don't have arthritis.

Posted by: agreed, the article is less than clear | September 11, 2008 8:49 AM | Report abuse

To surgically literate-
I got the point by the end of the second paragraph... and I dont consider myself 'surgically literate'. So might be a good time to rethink your view of the general population. ;-)

Posted by: Lancruiser | September 11, 2008 8:58 AM | Report abuse

I'm 43 and I had knee surgery about 7 yrs ago. I remember fighting with my doctors and my insurance company about having it since they didn't see the need for it. After the surgery was done, the surgeon told me of all the damage that my knee suffered and the amount of debris (cartiledge and other stuff that he removed. I wonder if the surgery was done sooner would I be in the amount of pain I'm in everyday. The study will only give insurance companies more motive to deny the surgery to others. I wonder why the study was only done on older patients. What about folks my age that have knee issues?

Posted by: naner | September 11, 2008 9:16 AM | Report abuse

I'm 43 and had clean-out surgery done on both my knees, one in 2005, the other in 2006. I'm absolutely pain-free after having some persistent problems, and am extremely happy with the results. In my case apparently there were some rice grain-sized bone chips my femur had knocked off my patella, so that may be different from many patients.

Posted by: Andrew | September 11, 2008 10:35 AM | Report abuse

Many of the comments seem to be veering off course--the study relates only to arthroscopy for problems related to arthritis, not other knee problems or conditions where the joint might need cleaning out.

Posted by: Gretchen | September 11, 2008 5:30 PM | Report abuse

Please stop posting stories of this procedure working for bone-chips or torn cartilage; it's well known that people with these issues should be "cleaned out." Has anyone with arthritis had this procedure done and then experienced long-term relief? Not knee-issues, but arthritis. That would make for an interesting post.

Posted by: PayAttention | September 11, 2008 5:58 PM | Report abuse

There are a number of types of arthritis. There is strong evidence that all are caused by infectious pathogens. Having an orthopedic surgeon mucking about with a gadgety high tech knife is the 21st century’s version or medical quackery. The medical profession would still be bleeding people like they did in the 18th century if they could get insurance to pay for it. We definitely need universal health care in this country but what we need more is for the medical professionals to emerge from practice of dark age medicine.

Posted by: Redman | September 11, 2008 10:45 PM | Report abuse

i had horrible knee pain in my 20's doc said i was torn cartilidge [avid squash player] every time i touched the ground i screemed. but the greater fear of an operation stopped me from having one. six months later it healed itself a long six months no pain to this day age 61...

Posted by: Anonymous | September 11, 2008 10:45 PM | Report abuse

Since age 14, 5 scopes, three arthrotomies and a total replacement at age 48. Same knee. All but the first related to arthritis. During this time the scopes were developed, thankfully, to debride and 'cleanup'. Far less invasive, much quicker recovery, etc. Agree with Surgically Literate above, with my literacy stemming from the patient's perspective.

Posted by: KW | September 11, 2008 11:05 PM | Report abuse

And which insurance comapany funded the study? Yeah, follow the money.

Posted by: mark | September 12, 2008 12:22 AM | Report abuse

The study was funded by the Canadian Institutes of Health Research. The VA study was funded by the National Institutes of Health.
Follow the money. It came from your tax dollars and might ecen save you a few of those dollars down the road.

Posted by: Jeff | September 12, 2008 4:02 PM | Report abuse

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