This common surgery works no better than a placebo so why bother? 39



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It’s widely believed it doesn’t work, has little to no long-term benefit and costs a fair whack, yet we all know someone who has either had this surgery or is considering it to alleviate pain.

Today the British Medical Journal has published yet another study showing that keyhole knee surgery for middle aged and older people provides very little benefit and could even cause harm. The report is part of the BMJ’s “Too Much Medicine” campaign that targets unnecessary care and treatments.

Evidence for the procedure, technically called arthroscopic surgery, is known to be weak, with all but one showing no added benefit, yet many specialists remain convinced it is the way to go for those suffering a painful arthritic knee or torn meniscus (the shock absorbing cartilage between the knee bones).

In this latest report, researchers based in Denmark and Sweden reviewed the results of 18 studies on the benefits and harms of arthroscopic surgery compared with a variety of control treatments (ranging from placebo surgery to exercise) for middle aged and older people with persistent knee pain.

Nine randomised trials involving 1,270 patients reported benefits of surgery. Patients ranged from 48 to 63 years and follow-up time varied between three and 24 months. Overall, the procedure was associated with a small but significant effect on pain at three and six months (but no longer). No significant benefit on physical function was found.

A further nine studies focusing on the harms found a number of adverse effects from the procedure. These included deep vein thrombosis (DVT), infection, pulmonary embolism (a blockage of the main artery of the lung), and death. These side effects were rare, but significant.

The report authors say, “Interventions that include arthroscopy are associated with a small benefit and with harms.”  They conclude that the benefit is “markedly smaller than that seen from exercise therapy” and that these findings “do not support the practice of arthroscopic surgery as treatment for middle aged or older patients with knee pain with or without signs of osteoarthritis”.

Writing in the British Medical Journal, Professor Andy Carr from Oxford University says, “It is difficult to support or justify a procedure with the potential for serious harm, even if it is rare, when that procedure offers patients no more benefit than placebo.”

In Australia, thousands of keyhole knee surgeries are carried out each year, despite local studies showing there are few benefits.

Professor David Hunter, a rheumatologist and osteoarthritis researcher at Sydney University, told the ABC earlier this year that arthroscopy rates remained steady. “That’s despite solid evidence to suggest that it’s no better than placebo or sham intervention… and compared to a whole range of other interventions,” he said.

In addition to the risks identified in the BMJ, Professor Hunter says the procedure can cause some people to need a joint replacement sooner than they would have without surgery.

The professor added that he believes orthopaedic surgeons are less likely to believe the evidence against arthroscopy because of the “remunerative benefit”. Surgery costs around $6000 and rates are higher among Australians with private health insurance.

Tell us, have you had keyhole knee surgery or do you know someone who has? What are your experiences? 


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  1. I had to have total knee replacement Stacey, and it was the best thing I have ever done. I was at the stage where I could not walk. Now I walk every day.

    1 REPLY
    • Glad to hear that. I’ve been putting off. Knee replacement because I’m worried about it ending up being worse!

  2. My right knee developed a Baker’s Cyst, 10 yrs ago … suddenly blew up like a football. No pain, but my doctor offered two treatments: a) syringe evacuation of the fluid (with risks); b) an arthroscopy after an MRI showed meniscus damage. I went with the arthroscopy and had a long recovery … lost a lot of movement after that and I have experienced a lot of pain in the past couple of years. I saw an orthopeadic surgeon a few months ago and he said I needed a knee replacement, but I was too young at 63 yrs old. Treatment? Take more walks (which I do anyway) … I wonder about my choice in 2005 …

  3. I had it 3 years ago with great improvement and it still is great rarely any pain. I think the surgeon who does the procedure counts a lot

  4. I couldn’t step down 1 step or walk down slopes without excruciating knee pain. I had bilateral arthroscopic surgery to blast out the osteo arthritis in both knees 4 years ago. I can now walk up and down stairs & slopes. The only thing that causes me pain is kneeling. Good result for me. Means I can still work as a nurse at 66.

  5. I had this surgery, it didn’t work the pain was worse, then a year on a trial drug which helped, now waiting for knee replacement.

    1 REPLY
    • Decided not to have keyhole and opted straight for knee replacement had both knees replaced on the same day glad it did

  6. I had one done. Being a private patient I thought that I was covered financially. Not so. Got hardly anything back from private health. Those doctors are astute business men and don’t like to let a patient trough their greedy fingers.
    At the end of the day it’s all about the money.
    Not so long ago for example when you broke a limb I got set and nature would heal your break.
    Your body is an amazing vessel often able to repair itself.
    Nowadays however it doesn’t matter what kind of break you have, you’ll probably need surgery to put a handful of screws in you body.
    Big business to be an orthopaedic doctor.

    1 REPLY
    • It only cost me $200 gap with private cover. Mind you that was 12 years ago.

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