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Report: Knee Surgery for Pain May Not Be Worthwhile

Only 'short-term marginal benefit' can be expected, expert says

Middle-aged and older adults with torn cartilage or painful arthritis in their knee are not likely to benefit from arthroscopic surgery and could be harmed by it, a review of past studies suggests.

Researchers reviewed nine previous trials with a combined total of 1,270 patients and found that surgery was no better than other options, such as exercise, for improving physical function, and was only temporarily more effective at easing knee pain.

“Patients and doctors should seriously consider if this treatment is the right choice given that only a short-term marginal benefit can be expected and that the procedure comes with a risk of serious complications,” lead author Dr. Jonas Thorlund, of the University of Southern Denmark, told Reuters in an email.

Worldwide, more than 4 million people undergo arthroscopic knee surgery each year, according to the American Orthopedic Society for Sports Medicine.

Thorlund and his colleagues reviewed previous research that compared patients receiving arthroscopic surgeries to remove damaged tissue or torn meniscus cartilage with control groups receiving interventions ranging from exercise to placebo therapy. After surgery or the alternative treatment, follow-up ranged from 3 to 24 months.

For pain relief, the researchers found a small but statistically significant benefit from knee surgery after 3 months and 6 months, but not later. Moreover, during the periods measured in the studies, there was no difference in physical function after surgical or nonsurgical interventions.

The most commonly reported adverse event was deep-venous thrombosis, which occurred in approximately four out of every 1,000 patients. Other serious adverse events included infection, pulmonary embolism, and death.

Many of the studies reviewed didn’t randomly assign patients to surgery or another option, making it hard to compare the safety of different alternatives, the authors acknowledged. In addition, the exercise therapy in some studies didn’t provide sufficient activity or was done in addition to surgery, making it difficult to assess the benefit of physical therapy in addressing knee problems, the authors noted.

Even so, the study findings add to a growing body of evidence that may be approaching a tipping point against arthroscopic knee surgery for pain, Dr. Andy Carr, of the Oxford University Institute of Musculoskeletal Sciences, wrote in an editorial accompanying the study.

“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,” Carr told Reuters in an email.

Sources: Reuters; July 19, 2015; BMJ; June 16, 2015; and BMJ Editorial; June 16, 2015.

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