If you have osteoarthritis, arthroscopic surgery with debridement to “clean up” your arthritic knee is no more beneficial than having Advil or Tylenol and physical therapy. This is according to a new study in the New England Journal of Medicine, which is the second prominent study to come to this conclusion, but orthopaedic surgeons have continued performing the surgery in an attempt to improve the wellbeing of patients with osteoarthritis.
According to the study’s authors ‘We conducted a single-centre, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic débridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone.’
The researchers noted, ‘The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).’ The researchers added that ‘Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.’
The same findings were reported in 2002 in a large study done by the Department of Veterans Affairs, but in spite of this, it is doubtful that orthopaedic surgeons will decrease the number of procedures that they perform. This is because patients whose wellness is affected by arthritic pain will almost always fit in to one of the clinical indications for arthroscopic knee surgery, which include suspected ligament tear, damaged meniscus cartilage, evidence of bone fragments from a fracture, joint pain from an injury, unexplainable joint pain, lesions or other problems detected by x-rays, joint disease and a need for joint surgery.
If you are such a patient, you may also have unrealistic expectations of what surgery can do for you. Arthroscopic surgery is often very helpful in athletes with injuries, and so patients with abnormalities on MRI scans believe they, too, can be relieved of chronic pain with surgery. Yet, the research clearly shows that the meniscus tears and other joint abnormalities that patients with arthritis suffer with have nothing to do with their pain and they do not respond to surgery. Therefore, studies like this highlight the need for physicians to limit unnecessary and costly surgery when it does little to help.
Comments are closed.