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.
September 10, 2008; 5:00 PM ET
Categories: Nutrition and Fitness , Seniors
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