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Common Knee Surgery Ineffective, Study Says
September 11, 2008
By ROBERT TOMSHO, WSJ
A common surgery for osteoarthritis of the knee isn't effective in treating patients with moderate to severe forms of the disease, according to a new study.
Canadian researchers found that such patients who underwent arthroscopic surgery did no better afterwards than those treated with medicine and physical therapy. The study bolsters previous findings.
About 985,000 Americans had arthroscopic knee surgeries in 2006, according to federal estimates. Researchers estimate that about a third of such surgeries are for osteoarthritis.
About 27 million Americans suffer from the pain and stiffness of osteoarthritis, the most common form of arthritis, caused by the breakdown of cartilage in the joints.
In arthroscopic knee surgery, a surgeon typically inserts a tiny camera through one small incision and then makes others to use various instruments to remove cartilage fragments, bone spurs and other debris.
For the study, published in this week's New England Journal of Medicine, researchers divided 178 patients into two groups. Both received physical therapy along with medical treatment such as anti-inflammatory drugs and injections designed to reduce pain. Patients in one of the groups also underwent arthroscopic surgery.
Researchers at the University of Western Ontario then evaluated the patients over a two-year period, using a scoring system designed to measure pain, stiffness and physical function.
After three months, the surgery group showed more improvement but those gains soon disappeared and after two years, there was no significant difference between the groups.
In 2002, a study involving patients recruited from the Houston Veterans Affairs Medical Center came to a similar conclusion. It found no significant difference between patients who underwent surgery for osteoarthritis of the knee and those who underwent a placebo procedure in which a doctor made incisions in patients' knees but didn't actually carry out arthroscopic surgery.
"We now have two independent, well-controlled trials that demonstrate that the procedure is ineffective," said Brian Feagan, one of the researchers involved in the just-published Canadian study. "I think that will change practice."
Patience White, chief public health officer for the Arthritis Foundation, an Atlanta-based nonprofit, said that, at the very least, such findings will make more patients and physicians try other therapies before considering surgery. "Before, it would have been something you thought of right away," said Dr. White, who wasn't involved with the study.
In an accompanying commentary in the Journal, Robert G. Marx, an orthopedic surgeon at Weill Medical College of Cornell University, said the study provided "strong support" for the conclusion that "arthroscopic surgery is not effective therapy for advanced osteoarthritis of the knee."
But in an interview, Dr. Marx said such surgery may still be a good option for patients who have knee problems in addition to osteoarthritis.