A landmark Canadian study has found that one of the most common and widely performed knee operations is ineffective and doesn't provide significant benefits for osteoarthritis patients.
Researchers found that patients who had arthroscopic knee surgery fared no better and had no long-lasting pain relief compared with those who were treated with a combination of physical and medical therapy.
The results, published today in the New England Journal of Medicine, support similar findings of a U.S. study conducted several years ago, and are significant enough to prompt immediate changes in clinical practice to prevent patients from unnecessarily undergoing a procedure that may not yield tangible benefits, said Bob Litchfield, co-lead author and medical director of the Fowler Kennedy Sport Medicine Clinic at the University of Western Ontario.
"I don't think there is enough of a benefit to warrant the procedure in a majority of patients," Dr. Litchfield said.
Arthroscopic surgery is considered to be a minimally invasive procedure in which a small instrument, called an arthroscope, is inserted into an incision in the knee to remove cartilage fragments and repair damage.
The procedure is often performed on people who have osteoarthritis in their knees.
Osteoarthritis is the most common type of arthritis and is typically the result of wear and tear on the joints over time.
The majority of knee procedures performed in Canada between 1994 and 2000 were arthroscopic, according to
a report published by the Public Health Agency of Canada.
Despite the popularity and widespread use of arthroscopy, the new study should cause medical professionals
to reconsider performing
the surgery, said Brian Feagan, co-lead author of the study and director of the
clinical trials unit at the Robarts Research Institute of
the University of Western Ontario.
"The burden of the evidence is very strong that this isn't effective," he said. "I wouldn't advocate the performance of this surgery."
In the study, conducted
between January, 1999, and August, 2007, researchers
randomly assigned nearly
200 patients with moderate to severe osteoarthritis to receive either arthroscopic surgery or physical and medical therapy.
Dr. Feagan said the research took an unusually long time to complete as the result of a plane crash that killed the study's designer, Alexandra Kirkey, as well as her husband, in 2002.
Significant controversy and criticism greeted the U.S.-based study published several years ago in the New England Journal of Medicine that first reported the limited effectiveness of arthroscopic surgery.
Until now, the procedure's lack of effectiveness was not widely recognized by the medical community because patients were usually not followed for long periods after surgery.
While most patients report pain relief and other improvements in the weeks immediately following surgery, those assessments may be the result of a placebo effect, Dr. Litchfield said.
"That short-term benefit, I don't think, is enough of a benefit to warrant the procedure in a majority of the patients," he said.
These developments could have significant implications for people with osteoarthritis who turn to arthroscopy to cope with the crippling pain that can seriously affect their quality of life, according to the Canadian Orthopaedic Foundation.
"Because it's so small and it's so non-invasive, it is seen as an easy fix," said Angelique Berg, the association's president and CEO.
In many patients, the pain is severe enough to make physical therapy difficult, which may explain why many people turn to arthroscopy, she said.
"The pain is a deterring factor [for therapy]," Ms. Berg said. "If your knee hurt, would you feel like going for a jog?"
Popular surgery called into question
A new study concluded arthroscopic knee surgery is ineffective. The majority of knee procedures performed in Canada between 1994 and 2000 were arthroscopic.
-Damage to the articular cartilage, the smooth lining that covers the ends of the leg bones in the knee, can cause painful bone spurs to form.
-Arthroscopic surgery can involve trimming of these and bone spurs.
