9486 in the collection  

Common Knee Surgery Ineffective, Study Says

Ohanian Comment: More
evidence that the 'medical model' for
education is not all that it's cracked up to
be.

But we knew that.

By ROBERT TOMSHO


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.
[Knee Surgery]
Alamy

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.

— Robert Tomsho
Wall Street Journal
2008-09-11


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