Is knee surgery really the answer?

December 22, 2008 5:38:33 PM PST
A new study is touching off a debate about one of the most popular surgeries for active adults - arthroscopic knee surgery. Some experts now believe in some cases, it's unnecessary.

Like many patients his age, Ken Christopher's pain was in his knee.

Doctors at St. Francis Medical Center in San Francisco quickly diagnosed osteoarthritis, and the deterioration of the smooth surface area of the joint, known as articular cartilage.

The recommended treatment: arthroscopic surgery. In this minimally invasive procedure, doctors use a small camera and slender instruments to remove bone chips and torn cartilage

"Three weeks later I'm as good as new, and I'm not in any pain," said Christopher.

In fact, arthroscopy has become the most common surgical treatment for arthritic knees. But a new study suggests many of those surgeries are unnecessary, and don't provide any more relief than less invasive alternatives.

Researchers at the University of Western Ontario followed 178 patients. Roughly half received physical therapy, and pain medication and the others received arthroscopic surgery.

The team then tested both groups for improvement in function, and reduction of pain. In an interview provided by the university, the lead researcher said there was no statistical difference between the two groups, after several years.

"I think this is procedure that many people felt was effective we now know isn't effective. And I think the resources directed toward arthroscopic surgery for osteoarthritis, should be directed elsewhere," said Dr. Brian Feagan University of Western Ontario Lead Researcher.

"Anything you do studies on, you have to take with a grain of salt," said Dr. Susan Lewis from St. Francis Medical Center.

Dr. Lewis is the surgeon who operated on Ken Christopher's knee. While she doesn't criticize the study directly, she warns against applying the results to specific cases -- in part because of the complex physiology of the knee joint, which can cause pain in different ways for different patients.

"The actual biochemistry in an arthritic knee is different than in a healthy knee. Also in arthritic knees, there tend to be loose bits of articulate cartilage floating around, that can be really painful. They cause a chemical reaction that changes makeup of the knee that's irritating to the knee, that makes the knee swell," said Dr. Lewis.

She says removing the floating chips can often relieve the chronic swelling, and advanced diagnostics now give surgeons a better idea of which candidates are likely to benefit from an arthroscopic procedure.

Still, both sides agree on one point -- that this surgical fix is often temporary.

"There are plenty of patients we operate on that I tell them, 'you're probably going to need a total knee replacement at Somme point.' But it's hard to tell a 45-year-old you're going to need a knee replacement next, and if I can buy that person five-10 years, that's a big help," said Dr. Lewis.

One other area of agreement: St. Francis, like most sports medicine centers, will usually offer physical therapy first, to try to control symptoms of pain, then move on to surgical treatments if those fail.


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