Could it be that the naked in Times Square moment is approaching for knee arthroscopy? The most common orthopedic surgery on earth has taken a beating in the medical research, with study after study showing it’s not effective. Now a new British Medical Journal study has begun to look at knee surgery side effects vs. the benefit and it’s not pretty.
The history of the research on arthroscopic knee surgery has been brutal over the last 15 years. It all began with a study in early 2000s showing that knee surgery for arthritis was no better than a fake surgery. Next, does meniscus surgery work. Why then is arthroscopic knee surgery still so common? Tradition? Money? Lack of patient education? All of the above?
Nothing changes medical decision making like the US medical malpractice system, which generally sits and waits for research like the paper just published in the BMJ. The review of 9 studies looked at research on middle-aged and older patients with meniscus tears and/or knee arthritis. An analysis of patient reported pain relief after arthoscopies performed for knee pain showed that patients who underwent surgery experienced a lousy 2.4% more improvement in pain relief and no improvement in physical function compared to patients who engaged in exercise therapy. On the downside, the knee arthroscopy procedures increased short-term risks of deep vein thrombosis and other complications. More concerning is that the researchers note that patients who undergo any kind of knee surgery are more likely to require joint replacement at a younger age. In an editorial that was published at the same time, a professor of orthopedic surgery at the University of Oxford in England agrees that the clinical evidence supporting knee arthroscopy is weak. He states, “We may be close to a tipping point where the weight of evidence against arthroscopic knee surgery for pain is enough to overcome concerns about the quality of the studies, confirmation bias and vested interests. When that point is reached, we should anticipate a swift reversal of established practice.”
The upshot? Based on the research that we have, knee arthroscopy performed because someone’s knee hurts and there is some finding seen on an MRI (like a meniscus tear) is a bad idea. I think it’s just a matter of time before we begin to see a dramatic decrease in these surgeries.