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

Knee surgery not necessary

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.

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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.

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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?