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Knee Surgeries May Not Be Needed

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The Associated Press

Published: September 11, 2008

Two studies call into question whether many people with arthritis are needlessly undergoing one of the most common operations in America: arthroscopic knee surgery.

One finds that surgery is no better than medication and physical therapy for relieving the pain and stiffness of moderate or severe arthritis. The other reveals that tears in knee cartilage - which often prompt such surgeries - are very common without causing symptoms.

Experts said the studies and other evidence show that arthroscopic knee surgery still has a place, such as after a recent injury, but should not be done routinely for osteoarthritis.

"A lot of people would prefer physical therapy, and their doctors would as well," said E. Anthony Rankin, spokesman for the American Academy of Orthopedic Surgeons.

The studies appear in today's New England Journal of Medicine.

About 1 million arthroscopic knee surgeries are done in this country each year, costing about $7,000, depending on the location, when done as an outpatient procedure.

A new study, done at the University of Western Ontario in Canada, was of nearly 200 patients with moderate-to-severe osteoarthritis in the knee. Researchers gave half medication, weekly physical therapy for three months and instruction on twice-daily exercises to do at home. The other half got those treatments, plus arthroscopic surgery.

Medications included anti-inflammatory drugs, Tylenol, glucosamine or chondroitin supplements, and injections of a knee lubricant. Therapy included exercises to strengthen knee muscles, and hot and cold packs.

After two years, both groups of patients reported the same pain levels, physical functioning and overall quality of life.

In the other study, researchers at Boston University School of Medicine and elsewhere examined MRI knee scans from 991 randomly selected people, ages 50 to 90. About one-third had a tear or other damage to the meniscus - a pair of cartilage pads that act as shock absorbers between the upper and lower leg bones - with prevalence increasing with age. But nearly two-thirds who had these knee cartilage tears had no pain or stiffness in the prior month.

JOINT-SAVING TIPS

Lose weight: Excess weight stresses hips, knees and other joints; every pound lost reduces the load exerted on the knee for each step by 4 pounds.

Get active: Exercise strengthens the muscles around joints, which can prevent cartilage from wearing down.

Stay straight: Good posture protects the neck, back, hip and knee joints.

Don't sit still: Switching positions can decrease joint and muscle stiffness.

Lift carefully: Use your biggest and strongest joints and muscles when lifting or carrying to avoid straining smaller joints.

Break it up: Rest between periods of heavy activity to prevent repetitive stress on joints that can accelerate wear and tear.

Don't overdo it: Get help for any job that's too physically demanding, and don't be a "weekend warrior" by jumping into sports your body isn't prepared to handle.

Source: Arthritis Foundation

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