Is Arthroscopic Surgery Worth the Risk for Mild Osteoarthritis of the Knee?
Mild osteoarthritis of the knee is often more than just a nuisance; and yet, the condition is not severe enough to warrant a total knee replacement. For years, orthopedic surgeons have been offering to “clean up” the mildly arthritic knee with arthroscopic surgery. But is knee debridement using arthroscopic surgery worth the risk?
In the United States, nearly 700,000 people per year think that arthroscopic knee surgery is worth the risk. Patients are promised less pain and more function at the risk of infection, nerve damage and blood clots. But if the knee is painful and has limited ability to tolerate activities, then these risks might be worth it. Or are they??
In a recent study looking at the benefits of knee surgery for mild osteoarthritis of the knee published in the Canadian Medical Association Journal, researchers examined multiple studies to answer the question of whether or not arthroscopic knee surgery helps improve short-term or long-term quality of life. (1) Surprisingly, they concluded that
“Arthroscopic surgery for degenerative meniscal tears in the setting of mild or no concurrent osteoarthritis in middle-aged patients may have little, if any, effect on short-term (< 6 mo) and long-term (< 2 yr) outcomes in comparison with nonoperative management”
Does this mean that 700,000 surgeries per year are worthless? Wow, insurance companies might find this very interesting. The researchers looked at two primary goals of surgery: reduced pain and improved function. Within six months of the surgery, there were insignificant improvements in both pain and ability to do activities. Long term results arthroscopic surgery were no better than conservative, nonoperative care either.
The researchers went on to say that
“With limited evidence supporting arthroscopic meniscal débridement for degenerative meniscal tears in the setting of mild or no concomitant osteoarthritis, an initial trial of nonoperative interventions should play a large role for middle-aged patients”
Based on these conclusions, thousands of individuals should be reconsidering arthroscopic surgery on the knee for mild osteoarthritis before entering the operating room. Conservative treatment offers the possibility of better results with little or no risk.
Conservative care starts with modifying activities to rest the knee while taking anti-inflammatory medications or eating an anti-inflammatory diet to reduce swelling will help a large majority of people with mild osteoarthritis of the knee. Some people might require physical therapy or other exercise regimens to strengthen the knee. Minimally invasive injections with platelet rich plasma or viscosupplementation might also be worth considering because there is virtually no risk. (2)
Conservative, non-operative treatment for mild knee osteoarthritis will not fleece the pockets of surgeons but it can keep thousands of people from undergoing the unnecessary risk and expense of arthroscopic knee surgery.
1) Khan, M; et al.; Arthroscopic Surgery for Degenerative Tears of Meniscus; Canadian Medical Association Journal; 2014, October 186 (14): 1057-64
2) Campbell, KA; et al_; Is Viscosupplementation Injection Clinically Superior to Other Therapies in Treatment of Osteoarthritis of Knee_; Arthroscopy; 2015; May 18: S0749-8063(15)00257-1
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.