NYTimes: Most Arthroscopic Knee Surgery “Complete Waste of Money”
If you’re like most adults, knee pain is a common occurrence. Almost everyone has knee pain occasionally, and one article from a few years ago suggested that about one-quarter of adults experience knee discomfort much of the time (a figure that doubles for those with arthritis). Even though the incidence of knee replacement surgery has risen dramatically in recent years, most people will do whatever they can to put off that invasive procedure as long as they can.
Now in this recent article from the pages of the New York Times, written by popular health columnist Jane Brody, we read this discomfiting news. “Many of the procedures people undergo to counter chronic knee pain in the hopes of avoiding a knee replacement have limited or no evidence to support them,” Brody writes. “Some enrich the pockets of medical practitioners while rarely benefiting patients for more than a few months.”
That’s quite an indictment of the medical industry, but in Brody’s case it comes not only from research but also from personal experience. (In fact the article is titled “What I Wish I’d Known About My Knees.”) It seems that Brody had developed severe knee pain when in her 50s after an active life of jogging, tennis and skiing. Her orthopedic physician recommended arthroscopic surgery, a common procedure often used (as in Brody’s case) to repair a torn meniscus. While the surgery helped alleviate pain for a while, it wasn’t long before it returned even worse than before. After yet another unsuccessful procedure (this time involving injections) designed to forestall surgery, Brody finally gave up and had both knees replaced and afterward was able to resume her active life.
“Serious questions are now being raised about the benefits of the arthroscopic procedures that millions of people endure in hopes of delaying, if not avoiding, total knee replacements,” writes Brody. In one recently published review of a dozen trials and 13 observational studies, a panel of clinicians reported that “arthroscopic surgery for degenerative knee arthritis and meniscal tears resulted in no lasting pain relief or improved function.” This review showed that fewer than 1 patient in 7 experienced “a small or very small improvement in pain and function” and, what’s worse, that those beneficial effects disappeared completely within a year.
Besides being virtually ineffective, arthroscopic surgery, like all invasive procedures, carries risks, especially the risk of post-operative infection. But those patients who avoid surgery altogether not only escape the attendant risks but seem to enjoy the best outcome. “Most patients will experience an important improvement in pain and function without arthroscopy,” the study quoted in the New York Times concludes.
In the words of one physician quoted by Jane Brody, arthroscopic surgery has its uses – for example, when used to treat younger patients with sports injuries – but is now believed to be unsuitable to treat knee pain caused by arthritis or meniscal tears. Brody writes, “The panel noted that about one-quarter of people older than 50 experience knee pain from degenerative knee disease, a percentage that rises with age. Arthroscopic procedures for this condition ‘cost more than $3 billion per year in the United States alone,’ the report stated, suggesting that it was a near-complete waste of money.”
What about steroid injections, another treatment commonly used to deal with knee pain? These can reduce inflammation, but at the same time continual use of steroids can speed up the onset of arthritis, according to a study in the Journal of the American Medical Association. JAMA said not only do steroids accelerate knee deterioration, but in a blind study compared against those receiving a placebo injection, the ones getting the steroids experienced “no significant difference in knee pain.”
Brody acknowledges what anyone with degenerative knee arthritis knows: finding the right treatment regimen can be frustrating for both doctors and patients. That’s because “there is no clear answer as to what will help which patients.” But here are some simple and generally accepted approaches that might help avoid or delay surgery, says the New York Times:
- “If you are overweight, lose weight.” Any extra weight puts more pressure on your knees.
- Avoid activities that aggravate knee pain if you can – things like squatting, sitting too long in one place, or climbing a ladder.
- Take an over-the-counter pain reliever if the discomfort is bad enough, but be careful to follow proper dosage instructions and your doctor’s recommendations.
- If the pain is really getting to you, physical therapy administered by a licensed therapist has been shown to have very positive effects. “Be sure to do the recommended exercises at home,” says Brody, “and continue to do them indefinitely lest their benefits dissipate.” You may even want to consult an occupational therapist who can teach you how to modify your activities to minimize knee discomfort.
We at AgingOptions would strongly recommend one more step: put your medical care into the hands of a geriatric physician, also called a geriatrician. These experts understand the aging body and can assist you with exercise, weight loss, and better nutrition to keep you (and your aging knees) healthier longer. Contact us here at our office and we’ll gladly recommend a geriatrician to you.
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(originally reported at www.nytimes.com)